Comparison of mivacurium and rocuronium in the microsurgery of the larynx
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Department of Anaesthesiology and Intensive Care, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland
Anaesthesiology and Intensive Care Clinical Ward, Clinical University Hospital in Olsztyn, Department of Anaesthesiology and Intensive Care, University of Warmia and Mazury in Olsztyn, Poland
Lidia Glinka   

Department of Anaesthesiology and Intensive Care, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Warszawska 30, 10-082 Olsztyn, Poland. Tel.: +48601435003.
Submission date: 2021-02-17
Final revision date: 2021-05-13
Acceptance date: 2021-05-14
Online publication date: 2021-07-23
The introduction of sugammadex has created new opportunities for a quick reversal of relaxation caused by steroid relaxants.

The objective of this study was to compare relaxation of striated muscles in laryngeal microsurgery depending on the applied agent: mivacurium or rocuronium.

Material and methods:
65 low-risk surgery patients were randomly divided into two groups: MIV (n = 32) and ESM (n = 33) before the scheduled larynx microsurgery. The MIV group used mivacurium to relax the muscles, the ESM group used rocuronium.The following parameters were monitored: pulse rate, arterial blood pressure, arterial blood saturation, ventilation parameters according to the conventional standards and the depth and rate of neuromuscullar blockade (NMB) reversal. The demand for anesthetics and analgesics used during the anesthesia and the frequency of complication occurrence were evaluated.

Results and discussion:
There were no differences under intubation conditions. The conditions of the operation assessed by its operator were better in the ESM group. The time of the operation was similar in the two groups. The acting time of sugammadex in the ESM group was on average 1 minute. The ESM group reached train-of-four ratio (TOFR) of 0.9 (90% recovery of NMB) far more quickly than the MIV group. There was no statistical difference in side effects.

It seems to be reasonable to replace mivacurium with rocuronium and reverse its action by means of sugammadex in patients with a positive family history of allergy and anaesthetized for short-term operations or operations of unpredictable duration.

None declared.
Glanz HK. Zum 70. Geburtstag von Prof. Dr. Oskar Kleinsasser am 1. Dezember 1999. Laryngorhinootologie. 1999;78(12):649–650.
Saverese JJ, Ali HH, Basta SJ, et al. The clinical neuromuscular pharmacology of mivacurium chloride (BW B1090U). A short-acting nondepolarizing ester neuromuscular blocking drug. Anesthesiology. 1988;68:723–732.
Cooper R, Mirakhur RK, Clarke RS, et al. Clinical observations on the neuromuscular blocking action of Org 9426, a new steroidal non-depolarizing agent. Br J Anaesth. 1992;69:269–273.
Mallampati S, Gatt S, Gugino L, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J. 1985;32(4):429–434.
Shiga T, Wajima Z, Inoue T, Sakamoto A. Predicting difficult intubation in apparently normal patients: A meta-analysis of bedside screening test performance. Anesthesiology. 2005;103(2):429–437.
Wright PM, Caldwell JE, Miller RD. Onset and duration of rocuronium and succinylcholine at the adductor pollicis and laryngeal adductor muscles in anesthetized humans. Anesthesiology. 1994;81(5):1110–1115.
Kopman AE, Yee PS, Neuman GG. Relationship of the train-of-four fade ratio to clinical sings and symptoms of residual paralysis in awake volunteers. Anesthesiology. 1997;86(4):765–771.
Goldhill DR, Whitehead JP, Emmott RS, Griffith AP, Bracey BJ, Flynn PJ. Neuromuscular and clinical effects of mivacurium chloride in healthy adult patients during nitrous oxide- enflurane anaesthesia. Br J Anaesth. 1991;67(3):289–295.
From RP, Pearson KS, Choi WW, Abou-Donia M, Sokoll MD. Neuromuscular and cardiovascular effects of mivacurium chloride (BW B1090U) during nitrous oxide-fentanyl-thiopentone and nitrous-halotane anaesthesia. Br J Anaesth. 1990;64(2):193–198.
Diefenbach C, Buzello W, Mellinghoff H. Mivacurium chloride – a comparative profile. Acta Anaesthesiol Scand. 1995;39(s106):23–25.
Pendeville PE, Lois F, Scholtes JL. A comparison of intubation conditions and time-course of action with rocuronium and mivacurium for day case anaesthesia. Eur J Anaesthesiol. 2007;24(6):546–550.
Sorgenfrei IF, Norrild K, Larsen PB, Stensball J et al. Reversal of rocuronium-induced neuromuscular block by the selective relaxant binding agent sugammadex: A dose -finding and safety study. Anesthesiology. 2006;104(4):667–674.
Sparr HJ, Vermeyen KM, Beaufort AM, et al. Early reversal of profound rocuronium-induced neuromuscular blockade by sugammadex in a randomized multicenter study: Efficacy, safety and farmacokinetics. Anesthesiology. 2007;106(5):935–943.
Mirakhur RK. Sugammadex in clinical practice. Anaesthesia. 2009;64(Suppl 1):45–54.
Jones RK, Caldwell JE, Brull SJ, Soto RG. Reversal of profound rocuronium-induced blockade with sugammadex: A randomized comparison with neostigmine. Anesthesiology. 2008;109(5):816–824.
Moneret-Vautrin DA, Kanny G. Anaphylaxis to muscle relaxants: Rational for sin tests. Allerg Immunol. 2002;34(7):233–240.
Laxenaire M. Drugs and other agents involved in anaphylactic shock during anaesthesia. A French multicenter epidemiological inqury. Ann Fr Anaesth Reanim. 1993;12(2):91–96.
Michalska-Krzanowska G, Kurek M, Ratajski R. The incidence of anaphylactic reactions in 3560 patients undergoing TIVA with propofol, fentanyl and different neuromuscular blocking agents: A one-year retrospective study. Anestezjol Intens Ter. 2006;38(3):149–152 [in Polish].
Levy JH, Davis GK, Duggan J, Szlam F. Determination of the hemodynamics and histamine release of rokuronium (Org 9426) when administered in increased doses under N2O/O2-sufentanil anaesthesia. Anesth Analg. 1994;78(2):318–321.
Glinka L, Onichimowski D, Sieniuta P, Korecki A. [Sugammadex – two years in clinical practise]. Anestezjol Intens Ter. 2010;42(3):155–159 [in Polish].