Reversal of mivacurium chloride: edrophonium of spontaneous recovery in
microscopic laryngeal surgery.
Author(s): Ting CK, Lin SM, Yang YW, Tsai HJ, Lao HC, Chu YC, Tsai SK.
Affiliation(s): Department of Anesthesiology, Taipei Veterans General Hospital, School of
Medicine, National Yang-Ming University, 201, Sec. 2, Shi-Pai Rd, Pei-Tou 112,
Taipei, Taiwan, R.O.C.
Publication date & source: 2001, Acta Anaesthesiol Sin. , 39(4):157-62
BACKGROUND: A double-blind, randomized study was designed to compare the recovery
manner of mivacurium infusion with or without edrophonium reversal in microscopic
laryngeal surgery. Neuromuscular blockade was quantified using the train-of-four
stimuli to the ulnar nerve and quantification of the ratio of the fourth twitch
to the first twitch.
METHODS: With the approval of the Human Studies Committee of the Taipei Veterans
General Hospital and patient informed consent, 40 healthy (ASA I or II) patients
with age from 24 to 54 years, undergoing microscopic laryngeal surgery were
randomly selected for study. Mivacurium chloride 0.2 mg/kg was given
intravenously, and then it was given in continuous infusion to maintain muscle
relaxation at 90% twitch block during the procedure. At the end of operation,
mivacurium infusion was terminated. In a double-blind manner, group I patients (n
= 20) received intravenous edrophonium 1 mg/kg and atropine 0.01 mg/kg for
reversal when T1 was at 10% recovery whereas patients in Group II (n = 20)
received placebo in the same manner. Mean infusion rate, recovery index (RI50,
time from T1 25% to T1 50%; RI75, time from T1 25% to T1 75%), extubation time,
and discharge time between groups were compared. Nausea, vomiting, and
dysrhythmias were also documented until the patient was discharged from hospital.
RESULTS: The demographic data between two groups were similar. The recovery index
(RI75) for group I was shorter than that of placebo group (5.3 +/- 2.19 min vs.
7.3 +/- 0.9 min) and the difference was statistically significant (P = 0.017).
There were no statistically significant differences in mean infusion rate,
incidence of nausea and vomiting, and discharge time from the POR. The incidence
of tachycardia or arrhythmia in group I was significantly greater than that in
group placebo.
CONCLUSIONS: Mivacurium, a short-acting nondepolarizing agent, is a suitable
muscle relaxant for patients receiving microscopic laryngeal surgery. Recovery
time with the use of edrophonium as reversal agent was shorter than with placebo,
but extubation and discharge time did not differ in two groups. The time which
could be saved by the use of edrophonium for reversal of mivacurium to hasten the
maximal recovery appears to be less than a few minutes. Therefore, clinically,
the value of routine use of edrophonium to obtain a faster recovery does not
outweigh its demerits of cost and risk and is not worthy of recommendation.
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