Higher dosing, waiting longer or combining with an opioid improve mivacurium intubating conditions, particularly in older patients.

pearl

• L E H Vanlinthout, S H Mesfin, N Hens, B F Vanacker, E N Robertson, and L H D J Booij.
• Department of Anaesthesiology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
• Anaesthesia. 2014 Dec 1;69(12):1377-87.

AbstractWe systematically reviewed factors associated with intubation conditions in randomised controlled trials of mivacurium, using random-effects meta-regression analysis. We included 29 studies of 1050 healthy participants. Four factors explained 72.9% of the variation in the probability of excellent intubation conditions: mivacurium dose, 24.4%; opioid use, 29.9%; time to intubation and age together, 18.6%. The odds ratio (95% CI) for excellent intubation was 3.14 (1.65-5.73) for doubling the mivacurium dose, 5.99 (2.14-15.18) for adding opioids to the intubation sequence, and 6.55 (6.01-7.74) for increasing the delay between mivacurium injection and airway insertion from 1 to 2 min in subjects aged 25 years and 2.17 (2.01-2.69) for subjects aged 70 years, p < 0.001 for all. We conclude that good conditions for tracheal intubation are more likely by delaying laryngoscopy after injecting a higher dose of mivacurium with an opioid, particularly in older people.© 2014 The Association of Anaesthetists of Great Britain and Ireland.

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