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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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References

Aubier M, Murciano D, Lecocguic Y, Viires N, Pariente R. Bilateral phrenic stimulation: a simple technique to assess diaphragmatic fatigue in humans. J Appl Physiol 1985; 58: 58–64.Google Scholar
Chauvin M, Lebrault C, Duvaldestin P. The neuromuscular blocking effect of vecuronium on the human diaphragm. Anesth Analg 1987; 66: 117–122.Google Scholar
d'Honneur G, Slavov V, Merle JC et al. Comparison of the effects of mivacurium on the diaphragm and geniohyoid muscles. Br J Anaesth 1996; 77: 716–719.Google Scholar
Moerer O, Baller C, Hinz J, Buscher H, Crozier TA. Neuromuscular effects of rapacuronium on the diaphragm and skeletal muscles in anaesthetized patients using cervical magnetic stimulation for stimulating the phrenic nerves. Eur J Anaesthesiol 2002; 19: 883–887.Google Scholar
Savarese JJ, Ali HH, Basta SJ et al. The clinical neuro-muscular pharmacology of mivacurium chloride (BW B1090U). A short-acting nondepolarizing ester neuromuscular blocking drug. Anesthesiology 1988; 68: 723–732.Google Scholar
Lacroix M, Donati F, Varin F. Pharmacokinetics of mivacurium isomers and their metabolites in healthy volunteers after intravenous bolus administration. Anesthesiology 1997; 86: 322–330.Google Scholar
Laghi F, Harrison MJ, Tobin MJ. Comparison of magnetic and electrical phrenic nerve stimulation in assessment of diaphragmatic contractility. J Appl Physiol 1996; 80: 1731–1742.Google Scholar
Similowski T, Fleury B, Launois S, Cathala HP, Bouche P, Derenne JP. Cervical magnetic stimulation: a new painless method for bilateral phrenic nerve stimulation in conscious humans. J Appl Physiol 1989; 67: 1311–1318.Google Scholar
Mills GH, Ponte J, Hamnegard CH et al. Tracheal tube pressure change during magnetic stimulation of the phrenic nerves as an indicator of diaphragm strength on the intensive care unit. Br J Anaesth 2001; 6: 876–884.Google Scholar
Valta P, Buscher H, Sydow M, Burchardi H. Twitch airway and transdiaphragmal pressure in intubated patients. Int Care Med 1997; 23: 24.Google Scholar
Viby-Mogensen J, Ostergaard D, Donati F et al. Pharmacokinetic studies of neuromuscular blocking agents: good clinical research practice (GCRP). Acta Anaesthesiol Scand 2000; 44: 1169–1190.Google Scholar
Lowry DW, Mirakhur RK, Carroll MT, McCarthy GJ, Hughes DA, O'Hare RA. Potency and time course of mivacurium block during sevoflurane, isoflurane and intravenous anesthesia. Can J Anaesth 1999; 46: 29–33.Google Scholar
Wulf H, Hauschild S, Proppe D, Ledowski T. [Augmentation of the neuromuscular blocking effect of mivacurium during inhalation anesthesia with desflurane, sevoflorane and isoflurane in comparison with total intravenous anesthesia.] Anaesthesiol Reanim 1998; 23: 88–92.Google Scholar
Kirov K, Motamed C, D'honneur G. Differential sensitivity of abdominal muscles and the diaphragm to mivacurium: an electromyographic study. Anesthesiology 2001; 95: 1323–1328.Google Scholar
Hemmerling TM, Schmidt J, Hanusa C, Wolf T, Schmitt H. Simultaneous determination of neuromuscular block at the larynx, diaphragm, adductor pollicis, orbicularis oculi and corrugator supercilii muscles. Br J Anaesth 2000; 85: 856–860.Google Scholar
Hemmerling TM, Donati F. Neuromuscular blockade at the larynx, the diaphragm and the corrugator supercilii muscle: a review. Can J Anaesth 2003; 50: 779–794.Google Scholar
Cantineau JP, D'honneur G, Duvaldestin P, Porte F. Neuromuscular effects of rocuronium on the diaphragm and adductor pollicis muscles in anesthetized patients. Anesthesiology 1994; 81: 585–590.Google Scholar
Donati F, Meistelmann C, Plaud B. Vecuronium neuromuscular blockade at the diaphragm, the orbicularis oculi and adductor pollicis muscles. Anesthesiology 1990; 73: 870–875.Google Scholar
Derrington MC, Hindocha N. Comparison of neuromuscular block in the diaphragm and hand after administration of tubocurarine, pancuronium and alcuronium. Br J Anaesth 1990; 64: 294–299.Google Scholar
Pansard J, Chauvin M, Lebrault C, Gauneau P, Duvaldestin P. Effects of an intubating dose of succinycholine and atracurium on the diaphragm and the adductor pollicis muscle in humans. Anesthesiology 1987; 67: 326–330.Google Scholar
Goat VA, Yeung ML, Feldmann SA. The effect of blood flow upon activity of gallamine triethiodide. Br J Anaesth 1976; 48: 69–73.Google Scholar
Fischer DM, Szenohradzky J, Wright PMC, Lau M, Brown R, Sharma M. Pharmacodynamic modelling of vecuronium-induced twitch depression. Anesthesiology 1997; 86: 558–566.Google Scholar
Watson AC, Hughes PD, Louise HM et al. Measurement of twitch transdiaphragmatic, esophageal, and endotracheal tube pressure with bilateral anterolateral magnetic phrenic nerve stimulation in patients in the intensive care unit. Crit Care Med 2001; 29: 1325–1331.Google Scholar
Hedenstierna G, Tokics L, Lundquist H, Andersson T, Strandberg A, Brismar B. Phrenic nerve stimulation during halothane anaesthesia. Anesthesiology 1994; 80: 751–760.Google Scholar
Criner GJ, Travaline JM, Holt GA, Bosse CG, Kelsen SG. Variability of electrophrenic diaphragm twitch stimulation over the time in normal subjects. Respir Physiol 1999; 118: 39–47.Google Scholar
Aubier M, Murciano D, Lecocguic Y, Viires N, Pariente R. Bilateral phrenic stimulation: a simple technique to assess diaphragmatic fatigue in humans. J Appl Physiol 1985; 58: 58–64.Google Scholar
Wragg S, Aquilina R, Moran J et al. Comparison of cervical magnetic stimulation and bilateral percutaneous electrical stimulation of the phrenic nerves in normal subjects. Eur Respir J 1994; 7: 1788–1792.Google Scholar
Hamnegard CH, Wragg SD, Mills GH et al. Clinical assessment of diaphragm strength by cervical magnetic stimulation of the phrenic nerves. Thorax 1996; 51: 1239–1242.Google Scholar