Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-29T03:48:03.668Z Has data issue: false hasContentIssue false
  • English
  • Français

Decreased mivacurium infusion rate and delayed neuromuscular recovery after metoclopramide: a randomized double blind placebo-controlled study

Published online by Cambridge University Press:  19 April 2005

N. El Ayass  and
Ph. Hendrickx
N. El Ayass
Affiliation:
Hospital of Braine L'Alleud, Anesthesiology Department, Waterloo, Belgium
Ph. Hendrickx
Affiliation:
Hospital of Braine L'Alleud, Anesthesiology Department, Waterloo, Belgium
Get access

Abstract

Summary

Background and objective: Metoclopramide is an antiemetic drug which inhibits plasma cholinesterase activity. We have compared the mivacurium infusion requirements and neuromuscular recovery after administration of metoclopramide to a group of adults compared to a control group.

Methods: Forty-five patients were randomized into three groups. Two groups received either 10 or 20 mg of intravenous (i.v.) metoclopramide and the third group received i.v. saline. Metoclopramide and saline were given 5 min before i.v. induction of anaesthesia. Plasma cholinesterase activity was measured before induction and 30 min after metoclopramide or saline injection. Neuromuscular block was monitored by accelerography using single and train-of-four (TOF) stimulation. The mivacurium intubation dose was followed by an infusion titrated every 5 min to maintain 95% block until the end of surgery when the infusion was stopped. Recovery from mivacurium was then monitored until complete.

Results: Mivacurium infusion rates were significantly lower in the metoclopramide groups. After 45 min of infusion, the infusion rates were 1.82 ± 0.8 and 2.1 ± 1 μg kg−1 min−1 in the 20 and 10 mg metoclopramide groups, respectively, and 6.8 ± 2.7 in the saline group. Time to recovery of TOF to greater than 90% was significantly prolonged in both metoclopramide groups compared to the saline group: 33.2 ± 7.2 and 29.5 ± 10.3 min in the metoclopramide 20 and 10 mg groups, respectively, compared to 22 ± 3.9 in the saline group (P < 0.001 for the 20 mg group compared to control).

Conclusion: Metoclopramide enhances the effect of a mivacurium infusion.

Keywords

NEUROMUSCULAR NONDEPOLARIZING AGENTS, mivacurium, monitoring, recoveryMETOCLOPRAMIDEPSEUDOCHOLINESTERASE, inhibition, drug interactions
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 3 , March 2005 , pp. 197 - 201
Copyright
2005 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Henzi I, Walder B, Tramer MR. Metoclopramide in the prevention of postoperative nausea and vomiting: a quantitative systematic review of randomised placebo-controlled studies. Br J Anaesth 1999; 83: 761–771.Google Scholar
Kao YJ, Tellez J, Turner DR. Dose dependent effect of metoclopramide on cholinesterase and suxamethonium metabolism. Br J Anaesth 1990; 65: 220–224.Google Scholar
Nijs N, Duvaldestin P, Slavov V, Dhonneur G. Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity. Acta Anaesthesiol Scand 1998; 42: 1175–1179.Google Scholar
Motamed C, Kirov K, Combes X, Dhonneur G, Duvaldestin P. Effect of metoclopramide on mivacurium induced neuromuscular block. Acta Anaesthesiol Scand 2002; 46: 214–216.Google Scholar
Skinner HJ, Girling KJ, Whitehurst A, Nathanson MH. Influence of metoclopramide on plasma cholinesterase and duration of action of mivacurium. Br J Anaesth 1999; 82: 542–545.Google Scholar
Bevan JC, Reimer EJ, Smith MF, et al. Decreased mivacurium requirements and delayed neuromuscular recovery during sevoflurane anesthesia in children and adults. Anesth Analg 1998; 87: 772–778.Google Scholar
Gin T, Derrick JL, Chan MT, Chui PT, Mak TW. Post-partum patients have slightly prolonged neuromuscular block after mivacurium. Anesth Analg 1998; 86: 82–85.Google Scholar
Ostergaard D, Rasmussen SN, Viby-Mogensen J, Pederson NA, Boysen R. The influence of drug induced low plasma cholinesterase activity on the pharmacokinetics and pharmacodynamics of mivacurium. Anesthesiology 2000; 92: 1581–1587.Google Scholar
Perkel MS, Moore C, Hersh T, Davidson ED. Metoclopramide therapy in patients with delayed gastric emptying: a randomized double blind study. Digest Dis Sci 1979; 24: 662–666.Google Scholar
Wright RA, Clemente R, Wathen R. Diabetic gastroparesis: an abnormality of gastric emptying of solids. Am J Med Sci 1985; 289: 240–243.Google Scholar
Brock-Utne JG, Dow TG, Welman S, Dimopoulos GE, Moshal MG. The effect of metoclopramide on the lower oesophageal sphincter in late pregnancy. Anaesth Intens Care 1978; 6: 26–29.Google Scholar