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Decreased mivacurium infusion rate and delayed neuromuscular recovery after metoclopramide: a randomized double blind placebo-controlled study

Published online by Cambridge University Press:  19 April 2005

N. El Ayass  and
Ph. Hendrickx
N. El Ayass
Affiliation:
Hospital of Braine L'Alleud, Anesthesiology Department, Waterloo, Belgium
Ph. Hendrickx
Affiliation:
Hospital of Braine L'Alleud, Anesthesiology Department, Waterloo, Belgium
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Abstract

Summary

Background and objective: Metoclopramide is an antiemetic drug which inhibits plasma cholinesterase activity. We have compared the mivacurium infusion requirements and neuromuscular recovery after administration of metoclopramide to a group of adults compared to a control group.

Methods: Forty-five patients were randomized into three groups. Two groups received either 10 or 20 mg of intravenous (i.v.) metoclopramide and the third group received i.v. saline. Metoclopramide and saline were given 5 min before i.v. induction of anaesthesia. Plasma cholinesterase activity was measured before induction and 30 min after metoclopramide or saline injection. Neuromuscular block was monitored by accelerography using single and train-of-four (TOF) stimulation. The mivacurium intubation dose was followed by an infusion titrated every 5 min to maintain 95% block until the end of surgery when the infusion was stopped. Recovery from mivacurium was then monitored until complete.

Results: Mivacurium infusion rates were significantly lower in the metoclopramide groups. After 45 min of infusion, the infusion rates were 1.82 ± 0.8 and 2.1 ± 1 μg kg−1 min−1 in the 20 and 10 mg metoclopramide groups, respectively, and 6.8 ± 2.7 in the saline group. Time to recovery of TOF to greater than 90% was significantly prolonged in both metoclopramide groups compared to the saline group: 33.2 ± 7.2 and 29.5 ± 10.3 min in the metoclopramide 20 and 10 mg groups, respectively, compared to 22 ± 3.9 in the saline group (P < 0.001 for the 20 mg group compared to control).

Conclusion: Metoclopramide enhances the effect of a mivacurium infusion.

Keywords

NEUROMUSCULAR NONDEPOLARIZING AGENTS, mivacurium, monitoring, recoveryMETOCLOPRAMIDEPSEUDOCHOLINESTERASE, inhibition, drug interactions
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 3 , March 2005 , pp. 197 - 201
Copyright
2005 European Society of Anaesthesiology

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