Mf. Watcha et al., EFFECT OF ANTAGONISM OF MIVACURIUM-INDUCED NEUROMUSCULAR BLOCK ON POSTOPERATIVE EMESIS IN CHILDREN, Anesthesia and analgesia, 80(4), 1995, pp. 713-717
The routine use of cholinesterase inhibitors to antagonize residual ne
uromuscular block may be associated with increased postoperative emesi
s. Rapid spontaneous recovery from mivacurium may obviate the need for
these drugs. In this randomized, double-blind, placebo-controlled stu
dy of 113 healthy children who had received mivacurium as part of a st
andardized anesthetic regimen, we compared the incidence of postoperat
ive complications after spontaneous recovery and after the use of neos
tigmine-glycopyrrolate or edrophonium-atropine. The anesthetic regimen
consisted of halothane, nitrous oxide, fentanyl, 2 mu g/kg intravenou
s (IV), mivacurium in an initial dose of 0.2 mg/kg, followed by an inf
usion, adjusted to maintain greater than or equal to 1 evoked contract
ion response to a supramaximum train-of-four stimulus. At the end of t
he procedure, patients received by random assignment one of three drug
combinations: 1) neostigmine 70 mu g/kg + glycopyrrolate 10 mu g/kg,
IV, 2) edrophonium 1 mg/kg + atropine 10 mu g/kg, IV, and 3) saline. T
he trachea was extubated when evoked responses to peripheral nerve sti
mulation and clinical signs of adequate neuromuscular recovery were pr
esent. Postoperative pain was treated with morphine and emesis with me
toclopramide. There were no significant differences between the three
groups with respect to age, surgery, intraoperative fentanyl, and miva
curium use, time from the end of surgery to tracheal extubation, posta
nesthesia care unit (PACU) arrival and discharge, or in postoperative
oxygen saturation values and analgesic requirements. Compared to the p
lacebo group, emesis occurred more often in the PACU in patients recei
ving the neostigmine-glycopyrrolate combination, but not after edropho
nium-atropine. However, after discharge from the PACU, emesis rates we
re similar in the three study groups. We conclude that spontaneous rec
overy or reversal with edrophonium from a moderate degree of mivacuriu
m-induced block may offer advantages over the use of neostigmine, with
out increasing time to PACU arrival.