Onset time, duration of action, and intubating conditions after mivacurium in elderly and younger patients.

IF 1.9 4区医学 Q2 ANESTHESIOLOGY Acta Anaesthesiologica Scandinavica Pub Date : 2024-08-01 Epub Date: 2024-05-19 DOI:10.1111/aas.14440

Matias Vested, Sebastian Kempff-Andersen, Andreas Creutzburg, Helene Dalsten, Sarah Sofie Wadland, Oscar Rosenkrantz, Christine L Rosager, Lars S Rasmussen

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Abstract

Background: The neuromuscular blocking agent mivacurium can be used during anesthesia to facilitate tracheal intubation. Data on onset time, duration of action, and effect on intubating conditions in patients 80 years and older are however limited. We hypothesized that onset time and duration of action of mivacurium would be longer in elderly patients than in younger adults.

Methods: This prospective observational study included 35 elderly (≥80 years) and 35 younger (18-40 years) patients. Induction of anesthesia comprised fentanyl 1-3 μg kg^-1 and propofol 1.5-2.5 mg kg^-1 and propofol and remifentanil for maintenance. Acceleromyography was used for monitoring neuromuscular blockade. The primary outcome was onset time defined as time from injection of mivacurium 0.2 mg kg^-1 to a train-of-four (TOF) count of zero. Other outcomes included duration of action (time to TOF ratio ≥0.9), intubating conditions using the Fuchs-Buder scale and the intubating difficulty scale (IDS), and occurrence of hoarseness and sore throat postoperatively.

Results: No difference was found in onset time comparing elderly with younger patients; 219 s (SD 45) versus 203 s (SD 74) (difference: 16 s (95% CI: -45 to 14), p = .30). Duration of action was significantly longer in elderly patients compared with younger patients; 52 min (SD 17) versus 30 min (SD 8) (difference: 22 min [95% CI: 15 to 28], p < .001). No difference was found in the proportion of excellent intubating conditions (Fuchs-Buder); 31/35 (89%) versus 26/35 (74%) (p = .12) or IDS score (p = .13). A larger proportion of younger patients reported sore throat 24 h postoperatively; 34% versus 0%, p = .0002. No difference was found in hoarseness.

Conclusion: No difference in onset time of mivacurium 0.2 mg kg^-1 was found comparing elderly and younger patients. However, elderly patients had significantly longer duration of action. No difference was found in intubating conditions.

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老年和年轻患者服用米伐库铵后的起效时间、作用持续时间和插管条件。

背景：神经肌肉阻滞剂米伐库铵可在麻醉期间用于促进气管插管。然而，关于米伐库铵在 80 岁及以上患者中的起效时间、作用持续时间以及对插管条件的影响的数据十分有限。我们假设，米伐库铵在老年患者中的起效时间和作用持续时间要长于年轻人：这项前瞻性观察研究包括 35 名老年患者（≥80 岁）和 35 名年轻患者（18-40 岁）。麻醉诱导包括芬太尼 1-3 μg kg-1 和异丙酚 1.5-2.5 mg kg-1，维持麻醉则使用异丙酚和瑞芬太尼。加速肌电图用于监测神经肌肉阻滞。主要结果是起效时间，即从注射米伐库铵 0.2 毫克千克/升到四列数（TOF）为零的时间。其他结果包括作用持续时间（时间与 TOF 比率≥0.9）、使用 Fuchs-Buder 量表和插管困难量表（IDS）的插管情况以及术后出现声音嘶哑和咽喉痛的情况：老年患者与年轻患者的起始时间没有差异，分别为 219 秒（标清 45 秒）和 203 秒（标清 74 秒）（差异：16 秒（95% CI：10 秒））：16 秒（95% CI：-45 至 14），P = .30）。老年患者的作用持续时间明显长于年轻患者；52 分钟（标准差 17）对 30 分钟（标准差 8）（差异：22 分钟[95% CI：15 至 28]，P = .30）：老年患者与年轻患者相比，米伐库铵 0.2 mg kg-1 的起效时间没有差异。然而，老年患者的起效时间明显更长。在插管条件下没有发现差异。

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来源期刊

Acta Anaesthesiologica Scandinavica 医学-麻醉学

CiteScore

4.30

自引率

9.50%

发文量

157

审稿时长

3-8 weeks

期刊介绍： Acta Anaesthesiologica Scandinavica publishes papers on original work in the fields of anaesthesiology, intensive care, pain, emergency medicine, and subjects related to their basic sciences, on condition that they are contributed exclusively to this Journal. Case reports and short communications may be considered for publication if of particular interest; also letters to the Editor, especially if related to already published material. The editorial board is free to discuss the publication of reviews on current topics, the choice of which, however, is the prerogative of the board. Every effort will be made by the Editors and selected experts to expedite a critical review of manuscripts in order to ensure rapid publication of papers of a high scientific standard.