Mivacurium chloride 20mg/10ml solution for injection ampoules

PURPOSE: Mivacurium is a short-acting, non-depolarising neuromuscular blocking agent that provides adequate vocal cord myorelaxation during transoral laser microsurgery. This study aimed to determine the optimal dose of mivacurium by comparing the infusion rate delivered via a closed-loop target-controlled infusion system. METHODS: A prospective, randomized clinical trial was conducted on 60 patients undergoing laser-assisted laryngeal microsurgery for vocal cord tumours. All patients received an induction mivacurium dose of 0.2 mg kg -1 and were randomized to 3 groups, namely C1, C2 and C3, each receiving infusion rates of 6 μg kg -1 min -1 , 7 μg kg -1 min -1 , 8 μg kg -1 min -1 , respectively. Neuromuscular monitoring and pharmacodynamic para-meters of mivacurium were recorded. RESULTS: No cases of airway spasms, blood pressure or heart rate fluctuations were observed. Three patients had skin redness at the injection site. The onset time, no- response time, and recovery index (RI) of mivacurium did not differ significantly among the groups. However, additional mivacurium doses were needed for 15 patients in C1, 10 patients in C2, and 3 patients in C3 ( P 5.68 min was correlated with reduced mivacurium supplementation, and it was associated with no-response time and total mivacurium dose. The recovery index of all patients was also positively correlated with total mivacurium dosage ( p < 0.0001, r = 0.7838). CONCLUSIONS: A mivacurium infusion rate of 8 μg kg -1 min -1 offered the most favourable surgical field condition with no involuntary vocal cord movements, less need for supplementary doses, and fewer adverse reactions in laser-assisted laryngeal microsurgery.

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Purpose Low-dose propofol has a preventive effect on postoperative nausea and vomiting (PONV). Ciprofol is a new short-acting GABA A receptor agonist developed in China with a similar chemical structure to propofol, but its effect on PONV is unclear. This study examines whether administration of low-dose ciprofol immediately after the start of surgery reduces the incidence of PONV. Patients and methods In this study, this study enrolled 75 patients undergoing gynecological ambulatory surgery under general anesthesia, and randomly divided the patients into ciprofol group and normal saline control group. Both groups received remimazolam (6 mg/kg/h) until asleep, then alfentanil (20 μg/kg) and mivacurium (0.2 mg/kg) intravenous, followed by maintenance infusions of remimazolam and alfentanil. Five minutes after the start of the surgery, the ciprofol group was given 2 mL of ciprofol (5 mg) and the control group was given 2 mL of normal saline. The primary outcome measure was the incidence of PONV in the PACU. Secondary outcomes included the incidence of emetic episodes or nausea in the PACU and within 24 h, anesthetic time, wake-up time, and administered doses of remimazolam and alfentanil. Safety outcomes encompassed hypotension, hypertension, bradycardia, and tachycardia. Results The incidence of PONV in the PACU was significantly lower in the ciprofol group compared to the control group (16.2% vs 52.6%; RR=0.31; 95% CI, 0.14–0.68; ARR=0.364; p = 0.002). The ciprofol group also exhibited a lower incidence of emetic episodes (defined as retching, vomiting, or both) in the PACU (RR=0.27; 95% CI, 0.10–0.75; ARR=0.287; p = 0.005), as well as a lower incidence of nausea (RR=0.31; 95% CI, 0.14–0.68; ARR=0.364; p = 0.002). The frequency of emetic episodes or nausea within 24 h postoperatively was similar between the groups. There were no significant differences between the two groups regarding anesthesia time, wake-up time, remimazolam and alfentanil dosage, or safety indicators ( p &amp;gt; 0.05). Conclusion Low-dose ciprofol can effectively prevent PONV in PACU after gynecological day surgery under general anaesthesia remazolam combined with afentanil, but its effect is limited and cannot reduce the incidence of emetic episodes or nausea within 24 h after surgery. Clinical trial registration https://www.chictr.org.cn , identifier ChiCTR2300077247.

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Background: To explore whether the application of mivacurium can facilitate laryngeal mask airway (LMA) insertion and benefit patients. Methods: A total of 167 patients undergoing hysteroscopy were randomly divided into mivacurium (group M) and control (group C) groups. The anesthesia induction scheme was mivacurium + sufentanil + propofol in group M, whereas mivacurium was replaced with saline in group C. The main outcome was the LMA insertion condition Secondary outcomes included attempts and elapsed time of LMA insertion, intraoperative anesthetic consumption, perioperative hemodynamics, postoperative sore throat (POST), nausea, vomiting, dizziness, and agitation. Results: There was no difference in the baseline data (p > 0.05). There was no significant difference in mouth opening; however, the incidence of swallowing, coughing, body movement, and pharyngeal spasm in group M was lower (p < 0.001), and the proportion of no resistance during LMA insertion was higher (80.5% vs. 21.2%, p < 0.001). The success rate of first-attempt LMA insertion in group M was higher (98.8% vs. 48.2%, p < 0.001), the elapsed time was shorter (16.9 (9.0) vs. 73.0 (91.5) s, p < 0.001), and fewer patients needed additional propofol (1.2% vs. 54.1%, p < 0.001). Blood staining on the LMA surface showed no significant difference, but the postoperative pharyngeal pain score in group M was lower (1.0 (1.0) vs. 2.0 (1.0), p < 0.001). Intraoperative propofol and remifentanil consumption, postoperative dizziness and nausea were lower in group M. Conclusion: Mivacurium facilitates LMA insertion and reduce intraoperative anesthetic consumption and adverse reactions, such as POST, nausea, and dizziness,so as to benefit the patient. Clinical Trial Registration: clinicaltrials.gov, identifier ChiCTR2500101122.

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Background: Modified rapid sequence intubation (RSI) is crucial in emergency surgery, particularly for patients with a full stomach, as it allows for the administration of general anesthesia (GA). Objectives: This work aimed to evaluate mivacurium effectiveness and optimal dose in modified RSI. Methods: This randomized double-blind study involved 100 patients, aged between 20 - 60 years, of both sexes, with the American Society of Anesthesiologists physical status classification of I - III, who were undergoing emergency surgery under GA. Patients were randomized into two equal groups and received mivacurium in a dose of 0.3 mg/kg in group M1 or 0.4 mg/kg in group muscarinic-2 (M2). Results: Intubating conditions were significantly better in group M2 than in group M1. The onset of adequate muscle relaxation was significantly earlier in group M2 than in group M1 (P < 0.001). At the third minute, mean arterial blood pressure recordings were significantly lower in group M2 (P = 0.04) than in group M1. The recovery time was significantly longer in group M2 than in group M1 (P < 0.001). Conclusions: Mivacurium in a 0.4 mg/kg dose resulted in more favorable intubating conditions during RSI and a more profound, earlier onset of muscle relaxation, but with a longer recovery time compared to the 0.3 mg/kg dose.

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BACKGROUND: Succinylcholine is favored for its rapid onset and offset, but its use is limited by adverse effects. Mivacurium chloride, a non-depolarizing relaxant, offers a similar shorter duration and fewer cardiovascular effects, especially without worrying about muscle pain and hyperkalemia, making it a potential alternative in some short-time operations. This study aims to assess the non-inferiority of mivacurium chloride compared to succinylcholine in terms of muscle relaxation effect and safety during flexible bronchoscopy. METHODS: This is a prospective, single-center, randomized, assessor-blinded, positive-controlled trial. Participants scheduled for flexible bronchoscopy requiring muscle relaxation were randomly assigned to receive either mivacurium chloride or succinylcholine. The primary endpoint is the recovery rate of spontaneous breathing within 15 min after discontinuation of muscle relaxants. Other outcomes, including recovery time at different levels, hemodynamic changes, adverse events, and satisfaction from physicians and patients, are also collected. DISCUSSION: This study aims to compare the recovery effect of mivacurium chloride for muscle relaxation during bronchoscopy with succinylcholine, hypothesizing that mivacurium chloride is non-inferior in recovery time and superior in safety and comfort. TRIALS REGISTRATION: Chinese Clinical Trial Registry ChiCTR2400091276. Registered on 23 October 2024. CLINICALTRIALS: gov NCT06709066. Posted on 29 November 2024.

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Electroconvulsive therapy (ECT) remains the most effective method of treating acute mental conditions in psychiatry. The progress that has been made in anesthesiology in recent years allows for the personalization and optimization of electroconvulsive therapy through purely anesthetic interventions. There are few procedures in medicine where anesthesia would have such a direct impact on the effectiveness, or even success, of a given procedure. A key aspect of electroconvulsive therapy is a selection of the appropriate anesthetic. In Polish conditions, we have a choice of thiopental, propofol, etomidate, and ketamine - each with different, unique properties and a different impact on the generated epileptic seizure and the patient's hemodynamic safety. From the psychiatrist's perspective, etomidate and ketamine seem to be optimal, as they have no anti-epileptic effect and allow the use of lower energy values, which translates into a lower risk of cognitive dysfunction. However, their use is associated with more frequent cases of hypertension and tachycardia. Ketofol, a mixture of ketamine and propofol, helps to alleviate excessive increases in blood pressure and pulse rate through the hemostabilizing property of propofol. Another important issue is the dose of the anesthetic used, i.e., the depth of anesthesia, which can be monitored using the bispectral index. Too deep anesthesia will result in less effectiveness of the procedure itself. The flow of the electric current requires the patient's muscles to be fully relaxed. Succinylcholine, which is a depolarizing muscle relaxant, remains the drug of choice. In the case of contraindications to its use, non-depolarizing agents, such as mivacurium or rocuronium, turn out to be useful, although the duration of the procedure is definitely longer. Sugammadex allows for full abolition of rocuronium-induced relaxation, but it remains a drug that is usually unaffordable.

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BACKGROUND Mivacurium is a non-depolarizing neuromuscular blocking agent. TOF-Cuff® is a device that monitors intraoperative neuromuscular blockade and blood pressure. TOF-Scan® measures muscle relaxation status of an anaesthetized patient. This study included 36 patients aged 18 to 75 years presenting for elective surgery, to compare neuromuscular blockade measured using the TOF-Cuff of the upper arm and the TOF-Scan of the facial corrugator supercilii muscle during general anesthesia and following administration of mivacurium. MATERIAL AND METHODS Train-of-four (TOF) values were obtained every 30 s before intubation and successively every 5 min until extubation. RESULTS The median onset time for TOF-Cuff was longer than for TOF-Scan (210 s vs 90 s, P<0.00001). Multiplying the time to relaxation (according to TOF-Scan) by 1 to 8, respectively, provided concordance with the TOF-Cuff result for the following cumulative percentages of patients: 5.5%, 38.9%, 58.3%, 77.8%, 83.3%, 86.1%, 88.9%, and 91.7%. Analogue values for time to recovery from the last dose were 11.1%, 63.9%, 83.3%, 86.1%, 86.1%, 88.9%, 88.9%, and 91.7%. The proportion of patients who still had TOFratio=0 in the assessment performed at min 15 did not differ significantly between these 2 methods (P=0.088). Both TOF-Scan and TOF-Cuff showed a false-negative result in patients with clinical symptoms of preterm recovery; the numerical difference favored TOF-Cuff (1.6% vs 2.1%) but without statistical significance (P=0.2235). CONCLUSIONS When measurement on the limb is not possible, TOF-Scan on the eyelid can be an alternative for TOF-Cuff on the upper arm, if the time to relaxation is multiplied by at least 8, which is enough for 90% of patients.

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BACKGROUND To evaluate neuromuscular monitoring during anesthesia with mivacurium, this study assessed the correlation between measurements of TOF-Cuff® placed on the lower leg and stimulating the tibial nerve and TOF-Scan® values from the adductor pollicis muscle. Additionally, systolic (SBP) and diastolic (DBO) blood pressure measured in both locations were compared. MATERIAL AND METHODS Twenty-six patients participated in this observational clinical trial. The TOF-Cuff® was placed on the lower leg and the TOF-Scan® was placed on the thumb. Train-of-four (TOF) values were recorded simultaneously by both devices at 30-second intervals before intubation. Measurements continued every 5 minutes until extubation. Bland-Altman analyses compared TOF values obtained from the 2 devices. RESULTS Time to onset and relaxation time did not differ significantly; the number of patients presenting a lack of blockade despite TOF=0 was also concordant. The time from the last dose of mivacurium to TOF ratio >90 was shorter on the leg than on hand (median 20 [5-28, 0-65] min vs 30 [20-35, 0-60] min, p=0.025). The median (range, interquartile range) difference between measurements was: 11.6 (-41 to 45, 2-19) for SBP and -8 (-28 to 26, -15 to -4) for DBP at baseline (p=0.0495); 5 (-53 to 55, -2 to 9) for SBP and -11 (-45 to 29, -19 to -5) (p=0.0017) for DBP during the blockade. CONCLUSIONS Time-to-onset and SBP are comparable between these 2 methods, in contrast to time-to-recovery and diastolic blood pressure, and this should be considered in case of the inability to apply the TOF-Cuff on the leg.

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Abstract Background The neuromuscular blocking agent mivacurium can be used during anesthesia to facilitate tracheal intubation. Data on onset time, duration of action, and effect on intubating conditions in patients 80 years and older are however limited. We hypothesized that onset time and duration of action of mivacurium would be longer in elderly patients than in younger adults. Methods This prospective observational study included 35 elderly (≥80 years) and 35 younger (18–40 years) patients. Induction of anesthesia comprised fentanyl 1–3 μg kg −1 and propofol 1.5–2.5 mg kg −1 and propofol and remifentanil for maintenance. Acceleromyography was used for monitoring neuromuscular blockade. The primary outcome was onset time defined as time from injection of mivacurium 0.2 mg kg −1 to a train‐of‐four (TOF) count of zero. Other outcomes included duration of action (time to TOF ratio ≥0.9), intubating conditions using the Fuchs‐Buder scale and the intubating difficulty scale (IDS), and occurrence of hoarseness and sore throat postoperatively. Results No difference was found in onset time comparing elderly with younger patients; 219 s (SD 45) versus 203 s (SD 74) (difference: 16 s (95% CI: −45 to 14), p = .30). Duration of action was significantly longer in elderly patients compared with younger patients; 52 min (SD 17) versus 30 min (SD 8) (difference: 22 min [95% CI: 15 to 28], p &lt; .001). No difference was found in the proportion of excellent intubating conditions (Fuchs‐Buder); 31/35 (89%) versus 26/35 (74%) ( p = .12) or IDS score ( p = .13). A larger proportion of younger patients reported sore throat 24 h postoperatively; 34% versus 0%, p = .0002. No difference was found in hoarseness. Conclusion No difference in onset time of mivacurium 0.2 mg kg −1 was found comparing elderly and younger patients. However, elderly patients had significantly longer duration of action. No difference was found in intubating conditions.

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Adequate neuromuscular monitoring of patients is essential to verify complete recovery of neuromuscular function before tracheal extubation. This study aimed to assess the correlation between the values acquired from the brachialis muscle using TOF-Cuff and those obtained from the adductor pollicis muscle with TOF-Scan during anaesthesia with mivacurium. Twenty-five patients were enrolled in the observational clinical trial, with the TOF-Cuff positioned on the upper arm and the TOF-Scan on the thumb. Train-of-four (TOF) values were simultaneously recorded by both devices at 30-second intervals before intubation. Subsequently, measurements were taken every 5 min until the removal of the endotracheal tube. Bland-Altman analyses were conducted to compare assessed endpoints obtained by using the TOF-Cuff and the TOF-Scan. The median onset time measured with TOF-Cuff was numerically longer compared to the TOF-Scan score (120 s vs. 90 s, P = 0.42). Spearman rank correlation revealed a significant positive correlation between onset times measured by TOF-Cuff and TOF-Scan (R = 0.73, P = 0.0001, 95% CI 0.446 to 0.875). For the time to recovery assessed with both methods, Spearman correlation coefficient was R = 0.35 and did not reach statistical significance (P = 0.1). Multiplying the time to recovery from the last dose (according to TOF-Scan) by 0.43 to 2.66, provided concordance with the TOF-Cuff result for the entire range of study group. Conclusion. The concordance between the TOF-Scan on the adductor pollicis and the TOF-Cuff on the upper limb was found to be good. However, both devices showed a false-negative result in patients with clinical symptoms of preterm recovery.

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