Background: The present study compared the quality of neuromuscular block and costs after equipotent doses of mivacurium and vecuronium in the context of paediatric ENT surgery. Methods: A total of 30 children undergoing elective tonsillectomy were included and randomised in two groups (n= 15 for each) according to the neuromuscular blocking agent (NMBA) used. Anaesthesia was induced with alfentanil (15 μg/kg), propofol (3 mg/kg) and either 0.2 mg/kg mivacurium or 0.14 mg/kg vecuronium. For maintenance of anaesthesia propofol (8-12 mg/kg/h) was given. Neuromuscular block was assessed by electromyography using train- of four stimulation and the following parameters were quantified: Twitch height (T1) 2 min after the initial bolus of the myorelaxant; duration until recovery to 10% T1, number and duration of bolus injections of the myorelaxant needed to maintain neuromuscular block to a T1 <10%. In addition, the intubating conditions, number of patients needing pharmacological reversal at the end of surgery, adverse reactions and the costs for neuromuscular block and pharmacological antagonization were assessed. Results: Intubation conditions were comparable between both study groups: mivacurium - excellent: 7, good: 5, not acceptable: 1; vecuronium - excellent: 11, good: 4 (n.s.). T1 at 2 min was 16 (15)% for mivacurium and 6 (9)% for vecuronium (P<0.05). Time to 10% T1 recovery was 6.1 (1.7) min for mivacurium and 21.8 (3.7) min for vecuronium (P<0.01). In the mivacurium group 7 repetitive doses (range:4-18) were needed to maintain T1<10% during surgery, whereas children treated with vecuronium needed only 1 maintenance dose (range:0-2) (P<0.01). Two children in the mivacurium group and 11 in the vecuronium group required pharmacological reversal of the NMB at the end of surgery (P<0.01). The overall costs of NMB were significantly higher in the mivacurium group as compared to vecuronium 12.88 (4.5) Euro vs 9.96 (2.4) Euro; P<0.05. Conclusions: In conclusion, mivacurium-induced NMB is of very short duration in paediatric patients, and therefore repetitive doses are required to maintain a deep neuromuscular block. Nevertheless, residual paralysis is less frequent after mivacurium. The neuromuscular block after mivacurium was more expensive and residual paralysis less frequent compared to vecuronium.
- Anaesthesia, paediatric
- Anaesthetic techniques, total intravenous anaesthesia, propofol, alfentanil
- Cost analysis
- Measurement techniques, electromyography
- Neuromuscular blocking agents, mivacurium, vecuronium
ASJC Scopus subject areas
- Anesthesiology and Pain Medicine