Mivacurium Chloride in Patients with Chronic Renal Failure

Kim, Kyo Sang

Abstract

Mivacurium chloride(BW B1090U, mivacurium) was the second bis-benzylisoquinolinium diester compound in clinical deveopment. Short duration of action was emphasized as the most important clinical feature of this new drug, mainly due to its rapid hydrolysis by butyryl cholinesterase. Its hydrolysis rate in vitro by purified plasma cholinesterase approximated 88% of that of succinylcholine. The widespread use today of atracurium and vecuronium as the muscle relaxants of choice of patients with renal failure reflected their relatively larger systemic clearance rate and short duration of action. I have determined the neuromuscular blocking aetion of a bolus dose of mivacurium(0.2 mg/ kg) during 1-1.5% isoflurane and 50% nitrous oxide anesthesia in ten healthy patients and thirteen patients with chronic renal failure undergoing kidney transplantation. Neuromuscular block was assessed by measuring the electromyographic evoked response of the flexor carpi ulnaris muscle to train-of-four stimulation of the ulnar nerve with DATEX ABM. The results were as follows; 1) I found one of facial erythema, but did not find hypotension and taehycardia after the injection of mivacurium. 2) The onset, clinical duration(25%), 95% recovery time and recovery index(25-75%) after mivacurium was 2.28+/-0.35 min., 10.93+/-1.64 min., 25.72+/-3.42 min. and 6.77+/-1.75 min. in group 1, 2.41+/-0.22 min, 16.21+/-2.52 min., 35.17+/-3.68 min. and 9.09+/-3.29 min. in group 2(mean+/-SEM). There were no significance between two groups, but slightly inerease of clinical duration in group 2 was found. With the above results the author concluded that mivacurium was a reliable relaxant for outpatient and the patient with chronic renal failure due to short clinical duration, no cardiovascular effects and no changes in the patient with chronic renal failure.