Effects of Pseudocholinesterase and/or Neostigmine, Pyridostigmine, Edrophonium and Galanthamine for Reversal of Mivacurium- or Succinylcholine-induced Paralysis in Vitro / 대한마취과학회지

BACKGROUND: The hydrolysis of mivacurium and succinylcholine is impaired in the presence of defects of pseudocholinesterase. Clinical reports are conflicting as to the utility of anticholinesterases, in the reversal of mivacurium- or succinylcholine-induced paralysis. In this study, the role of exogenous bovine pseudocholinesterases (BpChE) and/or neostigmine, pyridostigmine, edrophonium or galanthamine in the reversal of mivacurium- or succinylcholine-induced paralysis, were investigated with the rat phrenic nerve-diaphragm preparation. METHODS: Ninety five Sprague-Dawley rats (200 g, male) were divided into 14 groups (n = 10). The phrenic nerve-diaphragm preparation mounted in a bath containing oxygenated Krebs' solution. Twitch response from diaphragmatic muscle evoked by phrenic nerve stimulation were measured. After stabilization of the twitch responses, mivacurium (0.1 microgram/mlml) or succinylcholine (0.1 microgram/ml) was administered incrementally in the preparation to obtain more than 95% twitch inhibition. BpChE (0.1, 1.0 u/ml), and/or neostigmine (0.1, 1.0 microgram/ml), pyridostigmine (0.5, 5 microgram/ml), edrophonium (0.01, 0.1 microgram/ml) or galanthamine (0.1, 1.0 microgram/ml) were added for the reversal of mivacurium- and/or succinylcholine-induced block in each group and the twitch responses (0.1 Hz) were monitored for 60 min. The effect of BpChE (0.1 u/ml), in combination with each of the above four anticholinesterases at lower concentrations also were examined. Twitch heights more than 75% was considered an adequatereversal. RESULTS: BpChE 0.1 and 1.0 u/ml were effective in reversal of mivacurium-induced paralysis. When anticholinestrases were added, there was no effective improvement of twitch height at the end of 60 minutes. In succinylcholine-induced paralysis, BpChE was effective for reversal, but when anticholinesterases were added, BpChE potency was inhibited. CONCLUSIONS: BpChE will reverse mivacurium-induced block more effectively than anticholinesterase. BpChE is effective in reversing succinylcholine block. The addition of anticholinesterases inhibits the activity of pseudocholinesterase.

Comparison of Onset Time of Mivacurium by Priming Principle with Succinylcholine during Endotracheal Intubation / 대한마취과학회지

BACKGROUND: Mivacurium has a characteristics of rapid onset and the shortest duration of non- depolarizing neuromuscular relaxants and the onset of action could be accelerate more rapidly by using priming principle. The purpose of this study was to compare the onset time of mivacurium by priming principle with succinylcholine during rapid endotracheal intubation. METHODS: 36 patients were randomly divided into 3 groups: mivacurium group by priming principle (Group 1), mivacurium group by bolus injection (Group 2) and succinylcholine group (Group 3). In Group 1, subparalyzing dose of 0.02 mg/kg was administered 2 minutes before principle dose of 0.25 mg/kg was given. Onset time and intubating conditions were observed when twitch tension was reduced by 25% block in each group. RESULTS: The onset of Group 1 (75 sec) was significantly faster than that of Group 2 (90 sec) (p<0.05) but was significantly slower than that of Group 3 (37.5 sec) (p<0.05). Intubating conditions were excellent in all groups. CONCLUSIONS: The attempts of priming principle with mivacurium could accelerate the onset of action of mivacurium compared with that of bolus injection but their onsets were shorter than those produced by succinylcholine.