Mivacurium

[Iso4ane]

So Mivacurium has made it back to the markets apparently. Anybody have experience with it? I understand its an ester so fast off, but what particular applications would it have? ECT?

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[btbam]

In peds world we use it all the time for quick hernias/appys/ENT cases. 0.2 mg/kg, wears off in about 15 min.

 

[BLADEMDA]

So Mivacurium has made it back to the markets apparently. Anybody have experience with it? I understand its an ester so fast off, but what particular applications would it have? ECT?

I used it a lot for a few years. Here is my take on it:

1. Very short acting- typically 5-10 minutes

2. Lots of histamine release at high intubating doses. I typically used 0.2-0.3 mg/kg because the stuff had a slow onsent. So, be aware of bronchospasm in smokers, asthmatics, etc. The higher the dose the more histamine release.

When administered rapidly at doses of 0.2 mg/kg or greater in adults, histamine release and transient hypotension have been observed.

3. I called it MIVACRAP because it took so long to onsent hence the name and 0.2-0.3 mg/kg dosage.

I liked the drug because we didn't have much else under 15 min in duration besides SUX. These days we have rocuronium and sugammadex for 15 min cases so Mivacrap is showing its age.
(I can give 0.3-0.4 mg/kg of Roc for intubation and most patients have at least 1 twitch by 15 minutes allowing a single vial of sugammadex to be used for reversal.)

 

[BLADEMDA]

Br J Anaesth. 1995 Nov;75(5):588-92.
Histamine-release haemodynamic changes produced by rocuronium, vecuronium, mivacurium, atracurium and tubocurarine.
Naguib M1, Samarkandi AH, Bakhamees HS, Magboul MA, el-Bakry AK.
Author information

Abstract
We have examined the effects of different benzyl-isoquinolinium and steroidal neuromuscular blocking compounds on plasma concentrations of histamine, heart rate and arterial pressure in surgical patients. A single, rapid (5-s) bolus of mivacurium 0.2 mg kg-1, atracurium 0.6 mg kg-1, tubocurarine 0.5 mg kg-1, vecuronium 0.1 mg kg-1 or rocuronium 0.6 mg kg-1 was administered to 75 patients (n = 15 in each group). Anaesthesia was induced with thiopentone 6 mg kg-1 i.v. and maintained with isoflurane and 70% nitrous oxide in oxygen. Venous blood samples were obtained before induction, 1 min after thiopentone and 1, 3 and 5 min after administration of the neuromuscular blocking drug. Mivacurium, atracurium and tubocurarine caused 370%, 234% and 252% increases in plasma histamine concentrations at 1 min, respectively. Corresponding values at 3 min were 223%, 148% and 157%, respectively. These changes were significant (P < 0.01) at 1 and 3 min. In contrast, the rocuronium and vecuronium groups had no significant changes in either plasma histamine concentrations or haemodynamic variables.

 

[drmwvr]

In adults, onset and duration were too variable to be of any use at all. I just used Zemuron which you could set your watch by and reverse. Generic roc isn't as predictable, but its still better that miv and there's suggamadex now anyway.

 

[Aether2000]

We used to use it but could never figure out if it was doing anything. Its onset was so slow that if you need to intubate within the first 5 minutes after giving the stuff, you were wrestling with the patient to keep them on the table during intubation. We surmised that in reality, Mivacron was really a placebo....

 

[nimbus]

We used to say it worked almost as well as saline. Roc/suga obviates the need for its existence.

 

[deleted697535]

Yeah it's ****e. Histamine histamine histamine. And slow ass hell. Id use remi to tube before going back to miv

 

[cchoukal]

Maybe-curium.

 

[Noyac]

Had a crna doing a case when I was supervising in my first PP gig. It was a short case and the pt had h/o pseudocholinesterase def. We did a very lose form of supervision back then, not usually present for induction, and I discussed sux with him. Never thought to discuss mivacurium. He gave it and we watched the pt in the PACU for a long time while tubed and on the vent waiting to recover.

 

[Planktonmd]

Intubating with Mivacurium is the same as intubating without muscle relaxant with histamine release as a bonus.

 

[d9sccr]

Intubating with Mivacurium is the same as intubating without muscle relaxant with histamine release as a bonus.

So you’re saying it will help blunt laryngoscopy?

 

[Planktonmd]

So you’re saying it will help blunt laryngoscopy?

No... I am saying it's equivalent to giving no muscle relaxant with induction.

 

[Noyac]

No... I am saying it's equivalent to giving no muscle relaxant with induction.

With some histamine induced hypotension which responds well to cold steel blades in the oropharynx.