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Mivacurium Administration in Children with Duchenne Muscular Dystrophy

Tobias, Joseph D. MD

doi: 10.1213/00000539-200002000-00050
Letters to the Editor
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SDC

The University of Missouri Department of Child Health Columbia, MO 65212

I read with interest the report of Uslu et al. (1) concerning mivacurium in a child with Duchenne muscular dystrophy (DMD). The authors state that there is no information concerning the use of mivacurium in DMD. In 1994, we published an article about a series of seven patients (8.3 to 14.4 yr old) in whom mivacurium was used to provide neuromuscular blockade during orthopedic procedures (2). After a bolus of mivacurium (0.2 mg/kg), the time to recovery of the first twitch varied from 12 to 18 min. Continuous infusion requirements varied from 3 to 20 μg · kg−1 · min−1. Although Uslu et al. suggested that patients with DMD have responses to mivacurium that are close to normal, our larger series demonstrates interpatient variability with increased sensitivity in some patients with a longer duration of neuromuscular blockade after a bolus dose and decreased infusion requirements when compared with children with normal neuromuscular function (3, 4). In our series, the patients’ sensitivity to neuromuscular blockade did not correlate with their preoperative status. We noted normal sensitivity in patients that were wheelchair users and increased sensitivity in those that were ambulatory. We agree that mivacurium may be preferred in DMD as prolonged durations of action have been noted with vecuronium and atracurium in this population.

Joseph D. Tobias MD

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References

1. Uslu M, Mellinghoff H, Diefenbach C. Mivacurium for muscle relaxation in a child with Duchenne’s muscular dystrophy. Anesth Analg 1999; 89:340–1.
2. Tobias JD, Atwood R. Mivacurium in children with Duchenne muscular dystrophy. Paediatr Anaesth 1994; 4:57–60.
3. Alifimoff JK, Goudsouzian NG. Continuous infusion of mivacurium in children. Br J Anaesth 1989; 63:520–4.
4. Brandom BW, Sarner JB, Woelfel SK. Mivacurium infusion requirements in pediatric surgical patients during nitrous oxide-halothane and during nitrous oxide-narcotic anesthesia. Anesth Analg 1990; 71:16–22.
© 2000 International Anesthesia Research Society