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Effects of mivacurium on the diaphragm evaluated by cervical magnetic stimulation of the phrenic nerves

Published online by Cambridge University Press:  29 June 2005

J. Hinz ,
P. Auer ,
O. Moerer ,
P. Neumann  and
T. A. Crozier
J. Hinz
Affiliation:
University of Göttingen, Department of Anaesthesiology, Emergency and Intensive Care Medicine, Göttingen, Germany
P. Auer
Affiliation:
University Regensburg, Klinik für Anästhesiologie, Regensburg, Germany
O. Moerer
Affiliation:
University of Göttingen, Department of Anaesthesiology, Emergency and Intensive Care Medicine, Göttingen, Germany
P. Neumann
Affiliation:
University of Göttingen, Department of Anaesthesiology, Emergency and Intensive Care Medicine, Göttingen, Germany
T. A. Crozier
Affiliation:
University of Göttingen, Department of Anaesthesiology, Emergency and Intensive Care Medicine, Göttingen, Germany
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Summary

Background and objective: Non-depolarizing neuromuscular blocking agents have differential effects on the diaphragm and skeletal muscles. We employed a new method to study the effects of mivacurium on the diaphragm and compared the results obtained with this method with published data. Methods: Anaesthesia was induced and maintained with propofol and alfentanil and the trachea was intubated after topical anaesthesia. Contractions of the diaphragm were induced by cervical magnetic stimulation of the phrenic nerves and quantified by measuring airway pressure responses. The neuromuscular effects on skeletal muscles were measured by acceleromyography of the adductor pollicis muscle. Mivacurium (0.15 mg kg−1) was injected and neuromuscular responses were recorded until the effects had waned. Results: Eleven male and 10 female patients (ASA I–II; 57 ± 16 yr; 78 ± 13 kg; mean ± standard deviation) participated. Median maximal reduction of twitch response was less (P < 0.05) for the diaphragm (89%) than for the adductor pollicis (100%). Time to 25% recovery was shorter for the diaphragm than for the adductor pollicis (8.8 ± 2.2 min vs. 22.6 ± 5.0 min, P < 0.05). The difference between the recovery index of the diaphragm (7.3 min (3.6–18.4)) and the adductor pollicis (8.2 min (4.4–20.9) (median (range)) just missed our chosen level of statistical significance (P = 0.06). The recovery time to train-of-four 0.8 was shorter for the diaphragm (median and 95% confidence interval 25.1 ± 10.2 min) than for the adductor pollicis (median and 95% confidence interval 37.5 ± 9.4 min, P < 0.05). Conclusions: The duration of the clinical effect of mivacurium on the diaphragm is markedly shorter than on the adductor pollicis muscles but there was only a small difference in the recovery index of the two muscles. These effects and the time courses determined with the new method closely resemble the results obtained with different methods in other studies.

Keywords

NEUROMUSCULAR NON-DEPOLARIZING AGENTS, mivacuriumDIAPHRAGM, monitoringADDUCTOR POLLICIS, monitoring, acceleromyographySTIMULATION, nerve, electric, magneticAIRWAY PRESSURE MONITORING, airway occlusion pressure
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 7 , July 2005 , pp. 530 - 535
Copyright
© 2005 European Society of Anaesthesiology

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