Table 1.
Clinical trials on NMBA use for outpatient surgery and reported side effects
| Authors | Title | Year | Number of patients |
Surgery | NMBA and dose | Induction agents | Reversal | Side effect |
|---|---|---|---|---|---|---|---|---|
| Raeder et al. [7] |
Outpatient laparoscopy in general anaesthesia with alfentanil and atracurium. A comparison with fentanyl and pancuronium |
1986 | 62 | Outpatient sterilization by laparoscopy |
Atracurium (0.5 mg/kg) or pancuronium (0.07 mg/kg) |
Fentanyl, alfentanyl |
Used, but drug was not specified |
Worst functionality after reversal of anaesthesia, in the afternoon after the procedure, and at home in the evening in patients with pancuronium. |
| Sengupta et al. [8] |
Post-operative morbidity associated with the use of atracurium and vecuronium in day-case laparoscopy |
1987 | Not available | Day-case gynaecological laparoscopy |
Atracurium or vecuronium |
Not available | Not available | Greater number of patients in the vecuronium group were able to resume normal activity 24 h after laparoscopy; significantly higher incidence of abdominal pain in the vecuronium group. |
| Melnick et al. [9] |
Decreasing post-succinylcholine myalgia in outpatients |
1987 | 395 | Healthy outpatients |
Succinylcholine (1.5 mg/ kg) |
Lidocaine and d- tubocurarine as premedication |
None | Succinylcholine without premedication is associated with a higher incidence of postoperative myalgia. |
| Sosis et al. [10] |
Comparison of atracurium and d tubocurarine for prevention of succinylcholine myalgia |
1987 | 44 | Outpatient females undergoing laparoscopy |
Atracurium and d tubocurarine |
Thiopental | None | Fasciculations occurred in 79 % of patients given saline, in 46 % of those receiving atracurium, and in 12 % of those given d-tubocurarine. 85 % of atracurium patients were free of postoperative myalgia on postoperative day 1. |
| Zuurond et al. [11] |
Atracurium versus vecuronium: a comparison of recovery in outpatient arthroscopy |
1988 | 40 | Outpatient arthroscopy of the knee under general anaesthesia |
Atracurium (0.5 mg/kg) and vecuronium (0.1 mg/kg) |
Methohexitone, isoflurane, N2O/O2 |
None | All but one patient (95 %) in the atracurium group required neostigmine versus nine patients in the vecuronium group (45 %). |
| Trépanier et al. [12] |
Myalgia in outpatient surgery: comparison of atracurium and succinylcholine |
1988 | 60 | Outpatient surgery |
Succinylcholine (1.5 mg/ kg) and atracurium (350 mg/kg) |
Isofluorane, fentanyl, and thiopentone |
None | Myalgia was present in 76 % of the succinylcholine patients compared to 23 % in the atracurium group. 50 % of the patients in the succinylcholine group had myalgia necessitating bed rest or analgesics compared to 23 % in the atracurium group |
| Zahl et al. [13] |
Muscle pain occurs after outpatient laparoscopy despite the substitution of vecuronium for succinylcholine |
1989 | 28 | Outpatient laparoscopy |
Succinylcholine (1.5 mg/ kg), vecuronium (50 mcg/kg) |
N2O, thiopental, and fentanyl. |
Glycopyrrolate (7 mcg/kg) and edrophonium (0.5 mg/kg). |
Rocuronium and succinylcholine are related with postoperative myalgia |
| Luyk et al. [14] |
Comparative trial of succinylcholine vs low dose atracurium-lidocaine combination for intubation in short outpatient procedures |
1990 | 40 | Surgical removal of molar teeth |
Atracurium (0.2 mg/kg), succinylcholine (1 mg/ kg) |
Halothane, lidocaine |
Edrophonium (0.5 mg/kg) and atropine (0.6 mg) |
Succinylcholine was related with significantly more myalgia. Spontaneous respiration was slower after low dose atracurium/lidocaine relative to succinylcholine |
| Poler et al. [15] |
Mivacurium as an alternative to succinylcholine during outpatient laparoscopy |
1992 | 60 | Female healthy outpatients |
Succinylcholine and mivacurium (0.15 mg/ kg) |
Thiopental sodium, alfentani |
Neostigmine | Side effects with mivacurium included flushing and occasional wheezing |
| Laxenaire [16] |
Drugs and other agents involved in anaphylactic shock occurring during anaesthesia. A French multicenter epidemiological inquiry |
1993 | 1585 | Outpatient clinics with allergo- anaesthesia unit |
Not available | Not available | Not available | Succinylcholine was responsible for 43 % of the IgE-dependent reactions involving a muscle relaxant, vecuronium for 37 %, pancuronium for 13 %, alcuronium for 7.6 %, atracurium for 6.8 % and gallamine for 5.6 % |
| Tang et al. [17] |
Comparison of rocuronium and mivacurium to succinylcholine during outpatient laparoscopic surgery |
1996 | 100 | Healthy women undergoing outpatient laparoscopic surgery |
Succinylcholine (1 mg/ kg), rocuronium (0.6 mg/kg), or mivacurium (0.2 mg/ kg) |
Midazolam, fentanyl and thiopental |
Edrophonium (0.5 mg/kg) and atropine (10 mcg/kg) |
One patient with succinylcholine and six patients with mivacurium displayed erythema on the upper body. Postoperative myalgia was experienced by 16 % of the patients with succinylcholine compared to none with rocuronium and mivacurium |
| Whalley et al. [18] |
Comparison of neuromuscular effects, efficacy and safety of rocuronium and atracurium in ambulatory anaesthesia |
1998 | 41 | Laparoscopic gynaecological surgery |
Rocuronium (0.6 mg/kg) or atracurium (0.5 mg/ kg) |
Propofol, alfentanil, N2O/O2 |
Used, but drug was not specified |
One patient in the atracurium group experienced transient flushing of the head and neck. The most frequent adverse event was nausea and vomiting (two patients in the rocuronium group; three patients in the atracurium group) |
| Savaresev et al. [19] |
The clinical neuromuscular pharmacology of mivacurium chloride (BW B 109 OU): a short- acting nondepolarizing ester neuromuscular blocking drug |
1998 | 72 | Healthy volunteers |
Mivacurium 0.03–0.30 mg/kg in boluses, and continuous infusions from 35 to 324 min in length |
N2O, narcotic and thiopental |
Neostigmine (0.06 mg/kg) and atropine (0.03 mg/kg) |
Long onset time (even when doses ED95×3 are used) and prolonged duration of action when higher doses are administered. In patients with atypical plasma cholinesterase, NMB may be prolonged |
| Debaene et al. [20•] |
Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action |
2003 | 526 | Gynecologic and plastic surgery |
Rocuronium (0.58 ± 0.08 mg/kg), atracurium (0.55 ± 0.08 mg/kg), and vecuronium (0.09 ± 0.02 mg/kg) |
Not reported | None used | After vecuronium, atracurium or rocuronium single intubating dose ED95×2 and no reversal, residual paralysis was still present 2 h after administration in almost 50 % of patients |
| Cammu et al. [21] |
Postoperative residual paralysis in outpatients versus inpatients |
2006 | 640 (320 inpatients and 320 outpatients) |
Outpatient surgery, not specified |
Mivacurium (50 %) for outpatients and, rocuronium (44 %) and atracurium (36 %) for inpatients |
Not reported | Used, but drug was not specified |
Postoperative respiratory complications: 38 % in surgical outpatients and 47 % inpatients. Mivacurium was used frequently for outpatients |
| Pendeville et al. [22] |
A comparison of intubation conditions and time-course of action with rocuronium and mivacurium for day case anaesthesia |
2007 | 50 | Outpatient surgery, not specified |
Mivacurium (0.15 mg kg−1) or rocuronium (0.3 mg kg−1) |
Propofol, sulfentanyl, N2O |
None used | Mivacurium has the risk of unexpected prolonged relaxation due to a possible defect in plasma cholinesterase |