Potency and time course of mivacurium block during sevoflurane, isoflurane and intravenous anesthesia

Abstract

Purpose: To determine the potency and time course of action of mivacurium neuromuscular block under routine clinical conditions during sevoflurane, isoflurane and intravenous anesthesia. Method: Patients were anesthetized with nitrous oxide 66% in oxygen and 1.5 MAC sevoflurane or isoflurane or a propofol infusion, neuromuscular block being monitored using mechanomyography. Potency was determined using administration of single doses of mivacurium of 40-100 μg · kg-1 and construction of dose-response curves (n = 72). The onset and duration of action were determined following a bolus dose of 0.2 mg · kg-1 of mivacurium (n = 30). Results: The ED50 and ED95 (with 95% confidence limits) were estimated to be 42 (35-51) and 86 (74-98) μg · kg-1, 52 (45-60) and 89 (72-110) μg · kg-1, and 53 (45-62) and 95 (81-112) μg · kg-1 during sevoflurane, isoflurane and propofol anesthesia respectively (P < 0.05 between sevoflurane and propofol). Following administration of the 0.2 mg · kg-1 dose, neither the times (mean ± SD) to maximum block (1.6 ± 0.31, 1.7 ± 0.21 and 1.6 ± 0.45 min, respectively) nor the times to 25 and 90% recovery of T1 (20 ± 4.5 and 33 ± 8.8 min, 21 ± 3.8 and 33 ± 6.5 min, and 18 ± 4.1 and 28 ± 5.8 min respectively) were different among groups. The times to recovery of TOF ratio to 0.8 were 40 ± 10.0, 36 ± 8.5 and 29 ± 5.5 min in the sevoflurane, isoflurane and propofol groups respectively (P = 0.017 between the sevoflurane and propofol groups). Conclusions: Under usual conditions of clinical anesthesia the potency of mivacurium was slightly enhanced during sevoflurane compared with intravenous anesthesia but the duration of action was only minimally prolonged during sevoflurane and isoflurane anesthesia.