We studied the influence of
mivacurium on the recovery profile following outpatient laparoscopic
tubal ligation in 60 healthy, nonpregnant women. After administration of
midazolam 2 mg intravenously (IV),
anesthesia was induced with
fentanyl, 2 micrograms/kg, and
thiopental, 4 mg/kg, IV. When the patient became unresponsive (loss of eyelid reflex), either
succinylcholine 1 mg/kg, IV (Group I), or
mivacurium 0.2 mg/kg, IV (Groups II and III), was administered to facilitate tracheal intubation.
Anesthesia was maintained with
isoflurane (0.5%-2% inspired concentration) in combination with 67% N2O in
oxygen. Muscle relaxation was maintained in all three groups with intermittent bolus doses of
mivacurium, 2-4 mg, IV. In Group III,
residual neuromuscular block was reversed with a combination of
neostigmine, 2.5 mg, and
glycopyrrolate, 0.5 mg, IV, at the end of the operation. In the postanesthesia care unit (PACU), patients in Group III had a significantly increased incidence of
postoperative nausea and vomiting compared to Group II. The use of
succinylcholine (versus
mivacurium) was also associated with more frequent
postoperative nausea and vomiting. However, these
emetic sequelae did not delay postoperative recovery times. In addition, a comparable number of patients in each treatment group required
analgesic medication for
postoperative pain. Although patients who received
succinylcholine complained of significantly more
neck pain during the 24-h period after discharge,
nausea,
vomiting, and
shoulder pain were similar in all three groups during this period. We conclude that
neostigmine and
glycopyrrolate may contribute to the development of
postoperative emesis when used for reversal of
residual neuromuscular block.(ABSTRACT TRUNCATED AT 250 WORDS)