Low dose mivacurium is less effective than succinylcholine in electroconvulsive therapy.

Abstract

PURPOSE:

To compare the efficacy of low dose (LD) mivacurium (0.08 mg.kg-1) with LD succinylcholine (0.5 mg.kg-1) in modifying seizure activity during electroconvulsive therapy (ECT). Partial muscle relaxation is used in ECT to prevent violent muscle contractions. Current practice is to use LD succinylcholine which has several undesirable side effects.

METHOD:

Sixteen depressed, but otherwise healthy, patients, aged 27-67 yr were studied. In a randomized, double-blind, cross-over study, either LD mivacurium or LD succinylcholine was given at consecutive ECTs 120 and 30 sec respectively before inducing ECT. Neuromuscular blockade following mivacurium was not reversed. Seizure modification was scored--0 = no seizure activity, 1 = over-modified, 2 = desired level, 3 = under-modified, 4 = unmodified. Duration of seizures, time to first breath and adequate ventilation, ability to protrude tongue and sustain hand grip for five seconds were recorded. Paired t-tests and Wilcoxon matched pairs test were used to compare data. P < 0.05 was considered significant.

RESULTS:

Seizure modification was better (mean (range)) after succinylcholine 2.06(1-3) than after mivacurium 2.56(2-4) (P < 0.05). Mivacurium was unsatisfactory in eight cases compared with two cases after succinylcholine. The study was terminated early because of unsatisfactory seizure control. Clinical assessments of recovery from both relaxants were similar.

CONCLUSION:

Low dose mivacurium is unsuitable for use in ECT.

• Authors: E W Cheam, L A Critchley, P T Chui, J C Yap, V W Ha
• Journal: Canadian journal of anaesthesia = Journal canadien d'anesthesie (Can J Anaesth) Vol. 46 Issue 1 Pg. 49-51 (Jan 1999) ISSN: 0832-610X [Print] United States
• PMID: 10078403 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Isoquinolines
• Neuromuscular Depolarizing Agents
• Neuromuscular Nondepolarizing Agents
• Mivacurium
• Succinylcholine

Topics

• Adult
• Aged
• Anesthesia Recovery Period
• Cross-Over Studies
• Double-Blind Method
• Electroconvulsive Therapy
• Female
• Hand Strength (physiology)
• Humans
• Isoquinolines (administration & dosage)
• Male
• Middle Aged
• Mivacurium
• Muscle Contraction (drug effects)
• Neuromuscular Blockade
• Neuromuscular Depolarizing Agents (administration & dosage)
• Neuromuscular Nondepolarizing Agents (administration & dosage)
• Respiration (drug effects)
• Seizures (prevention & control)
• Succinylcholine (administration & dosage)
• Time Factors
• Tongue (drug effects, physiology)