[maturner]

AS with many others, I would like to see more clinical type discussions on this board.

I was speaking with a mivacron rep last week and he was telling me that you can reliably get a block in 90 sec with miv. if you give .25 mg/kg in divided doses. (i.e. induction agent, .15 mg/kg miv, wait 30 sec, .10 mg/kg miv, and 60 seconds later have a complete block) Per the rep, divided doses are preferred to minimize histamine release.

Out of curiousity, I asked if they had heard of anyone using miv as an RSI drug? He replied that it is not labeled for rsi, but people have used it as such. I left it at that, but was curious if anyone has seen miv used in RSI situations?

I can't really think of a situation where the R&B of miv would outweigh the R&B of SUX or roc and be the preferred RSI drug.

What do you guys think?

[gaspassah]

as far as i know, roc and sux are the standard rsi paralytics. although short acting i dont really know how fast the onset is. i have used it for standard intubation and to get good conditions it usually takes about 4 minutes. i give divided doses in .2 mg/kg
anybody else?
d

[versatile_kat]

I don't know how mivacron could be considered an RSI agent, since you can't give an intubating dose of it the way it should be given - rapidly !. I have given it in cases where I only need a short time for paralysis (rigid bronch, vocal cord lesion excision, etc) and it's worked great.

[PTU2SLP]

I haven't seen or done it but have seen someone do a RSI with atracurium using half the dose, waiting a minute and then doing induction. I see no real benefit of doing either over Succs or Roc. Also, I believe if it failed and they aspirated or you couldn't intubate you'd be hung out to dry since literature doesn't support anything other than succs or Roc for RSI.

[athomas91]

i would think that regardless of what the rep states - if it isn't "labeled" or standard for RSI then if something goes wrong it will be anesthesia's butt in a sling...

just my 2cent

[gotosleep]

i don't know why anyone would use mivacron....terrible drug

[maturner]

Originally Posted by gotosleep

i don't know why anyone would use mivacron....terrible drug

Come on, You have to give us more than that! Why is mivacroin a terrible drug?

When I have used it, it has worked great. Short duration of action, no need to reverse, but you do have the option if you need to.

Please elaborate and stimulate the thread and forum.

[rn29306]

Originally Posted by gotosleep

i don't know why anyone would use mivacron....terrible drug

We call it "movacron" for patient usually assisting you in intubating by reaching for the tube or scope or "mivacrap" (enough said) at our facility.

[gotosleep]

Originally Posted by maturner

Come on, You have to give us more than that! Why is mivacroin a terrible drug?

When I have used it, it has worked great. Short duration of action, no need to reverse, but you do have the option if you need to.

Please elaborate and stimulate the thread and forum.

i really don't see a place for the drug. First and foremost, I dislike the histamine release that is far too common. The density of the block is often inadequate for laryngoscopy and the onset is too slow. The duration of action precludes its use on anything that requires real muscle relaxation. I would never give it to a child. In fact, I honestly can't think of one anesthetic scenario in which I would use mivacron in.

i'd much rather prefer using a low dose rocuronium or succinylcholine with a defasiculating dose of NDMR. I might add that the vast majority of my colleagues also believe it is a garbage drug and it is not even on our formulary. I've had all the exposure to mivacron that I'll ever need.

edit: anyone using it for a RSI is criminally stupid

r. moore CRNA

[jwk]

Originally Posted by rn29306

We call it "movacron" for patient usually assisting you in intubating by reaching for the tube or scope or "mivacrap" (enough said) at our facility.

Ditto. Really not a great drug. After all these years, sux still rocks!