Key result
Mivacurium 0.25 mg/kg in divided doses demonstrated noninferiority to rocuronium 0.9 mg/kg for the rate of excellent intubation conditions at 90 seconds (94.94% vs 100%, difference -5.06%, P=0.024).
Why the study?
Mivacurium is a short-acting nondepolarizing neuromuscular blocking agent with rapid, reliable metabolism, but whether it provides noninferior tracheal intubation conditions to rocuronium during rapid sequence induction remained to be investigated.
Does mivacurium in divided doses provide noninferior tracheal intubation conditions compared to rocuronium for rapid sequence induction and intubation in patients undergoing general anesthesia?
RCT (n=158)
Patient- and assessor-blinded
Computer-generated random numbers
No
Does mivacurium in divided doses provide noninferior tracheal intubation conditions compared to rocuronium for rapid sequence induction and intubation in patients undergoing general anesthesia?
Mean Difference: -5.06
Absolute Event Rate: 94.94% vs 100%
p-value: p=0.024
Mivacurium 0.25 mg/kg in divided doses provides noninferior excellent intubation conditions compared to rocuronium 0.9 mg/kg for rapid sequence induction, offering a viable alternative for short-duration surgeries.
Mivacurium provides a noninferior RSI option; extends alternatives for short-duration procedures in anesthesia.
Background ː Mivacurium is a short-acting nondepolarizing neuromuscular blocking agent (NMBA) with rapid and reliable metabolism. The aim of the present study was to investigate whether mivacurium provided tracheal intubation conditions noninferior to those of rocuronium for rapid sequence induction and intubation in patients undergoing general anesthesia. Methodsː A total of 158 patients receiving elective surgery were recruited and randomized to the mivacurium group (Group Miva, n=79) or rocuronium group (Group Rocu, n=79). Mivacurium 0.25 mg/kg in divided doses or rocuronium 0.9 mg/kg were given to the patients in Group Miva or Group Rocu, respectively, in combination with propofol, lidocaine, remifentanil, and ephedrine. The primary outcome was the rate of excellent tracheal intubation condition evaluated by Cooper’s scale 90 seconds after the initial dose of NMBAs. The secondary endpoints were mean arterial pressure and heart rate before and 10 minutes after induction at 1-minute intervals and adverse events. The non-inferiority margin was set as 10%. Resultsː The rates of excellent tracheal intubation conditions were 94.94% (75/79) in Group Miva and 100% (79/79) in Group Rocu. The difference was -5.06% (one-sided 97.5% confidence interval -9.96% to -∞), which satisfied the noninferiority hypothesis (P=0.024). Intubating conditions were clinically acceptable in all patients. Mean arterial pressure and heart rate were not significantly different during the induction period (P>0.05). Conclusionsː Compared with rocuronium 0.9 mg/kg, mivacurium 0.25 mg/kg in divided doses in rapid sequence induction demonstrated noninferiority with regard to the rate of excellent intubation conditions and provided hemodynamic variations comparable to rocuronium. Trial registrationː This study was registered with the Chinese Clinical Trial Registry on 02/05/2020 (URL: http://www.chictr.org.cn. Registry number: ChiCTR2000032571).
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Li et al. (2022) conducted an RCT in Elective surgery under general anesthesia (n=158). Mivacurium vs. Rocuronium 0.9 mg/kg was evaluated on Rate of excellent tracheal intubation condition evaluated by Cooper's scale 90 seconds after the initial dose of NMBAs (Difference -5.06%, 95% CI -9.96% to -∞, p=0.024). Mivacurium 0.25 mg/kg in divided doses demonstrated noninferiority to rocuronium 0.9 mg/kg for the rate of excellent intubation conditions at 90 seconds (94.94% vs 100%, difference -5.06%, P=0.024).
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