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.
I think there m i g h t be a rare occasion where someone could justify its use. Such as a strong contraindication for succs and a clear problem with the duration of action of roc
while i dont completely disagree with your comments, one thing i think you should bear in mind...
if you so choose to use miv and attempt to justify it's use, duration of action of roc will not hold up in court when the patient aspirated because they needed rsi (sux or roc). the literature (as far as i know) will only support roc and sux. therefore when you have an anesthesia provider as expert witness against you, duration of roc verus patient safety (aspiration) will be a losing issue for you. you always have the option of leaving the patient on the vent or waiting for ideal reversal conditions. no fault in either of these actions.
I would not use Mivacron for an RSI drug because the few times I have used it, I did not get great intubating conditions after 90-120 seconds. I did not however, use the divided doses, so I will try that and see if it makes a difference. I like Mivacron for the 25 min Lap Choles at the ASC, but I prefer to intubate with Sux and then give a dose of Miv for the duration of the case. I agree with the others that Roc and Sux are much better RSI drugs.
while i dont completely disagree with your comments, one thing i think you should bear in mind...
if you so choose to use miv and attempt to justify it's use, duration of action of roc will not hold up in court when the patient aspirated because they needed rsi (sux or roc). the literature (as far as i know) will only support roc and sux. therefore when you have an anesthesia provider as expert witness against you, duration of roc verus patient safety (aspiration) will be a losing issue for you. you always have the option of leaving the patient on the vent or waiting for ideal reversal conditions. no fault in either of these actions.
just my .02
d
I am with you Dave, Roc would be my choice and deal with the other issues after the airway is secured. My point was more trying to understand how someone could try rationalize the use of Mivacron in a similar situation.
gaspassah
457 Posts
while i dont completely disagree with your comments, one thing i think you should bear in mind...
if you so choose to use miv and attempt to justify it's use, duration of action of roc will not hold up in court when the patient aspirated because they needed rsi (sux or roc). the literature (as far as i know) will only support roc and sux. therefore when you have an anesthesia provider as expert witness against you, duration of roc verus patient safety (aspiration) will be a losing issue for you. you always have the option of leaving the patient on the vent or waiting for ideal reversal conditions. no fault in either of these actions.
just my .02
d