L’efficacité du mivacurium baisse si son injection est retardée par une prise de pression non-invasive sur le bras homolatéral

Abstract

Objective: We assessed the neuromuscular characteristics of 0.2 mg·kg –1 of mivacurium while its injection was concomitant to a non invasive blood pressure measurement in the ipsilateral arm. Patients: Thirty-one patients ASA I-II were randomized into two groups. Group cuff ( n = 15) and Group control ( n = 16). Methods: General anaesthesia was induced with fentanyl, thiopentone and mivacurium in all patients, however in the cuff group, measurement of non invasive blood pressure was performed immediately after the injection of mivacurium. Comparison was made on neuromuscular blockade of the adductor pollicis (AP) by mechanomyography, and intubating conditions which were guided by the visual estimation of the orbicularis oculi’s (OO) response. Results: In the cuff group, six out of 15 patients did not have complete blockade at the OO against one out of 16 in the control group, (Fisher exact test p < 0.05). Intubation time was significantly delayed in the cuff group, 201 ± 66 s versus 123 ± 32 s in the control group, ( t test p < 0.001). The maximum neuromuscular blocking effect at the AP was significantly greater in the control group 99 ± 2 % against 89 ± 7 % in the cuff group, ( t test p < 0.01). The onset of maximum blockade at the AP was longer in the cuff group 294 ± 40 s versus 179 ± 92 s, ( t test p < 0.001] in the control group. Time to 25 % recovery was shorter in the cuff group 16 ± 3 min versus 20 ± 5 min, in the control group ( t test p < 0.05). Conclusion: This study suggests that non invasive blood pressure measurement of the ipsilateral arm, concomitant to the injection of mivacurium decreases the potency of mivacurium. This finding is mostly explained by the early hydrolysis of mivacurium in the plasma of the excluded arm.