Emergencies
Conditions
Keywords
mivacurium, rapid sequence intubation, emergency surgery
Brief summary
Mivacurium can be considered as an optimal choice for muscle relaxation in short duration surgeries, as butyrylcholinesterase can rapidly and reliably degrade this benzylisoquinoline muscle relaxant in vivo. However the histamine release related to a rapid high-dose injection, unsatisfactory intubation conditions and unexpected delay in recovery in patients may be encountered with butyrylcholinesterase deficiency
Detailed description
Intubation in emergency and full stomach patients stands as a challenge in anaesthesia. Rapid sequence induction (RSI) is the key player technique in avoiding gastric contents aspiration risk. Non-depolarizing neuromuscular blocking agents as mivacurium are of clinical significance in the anesthetic management of patient. Mivacurium has been has been preferred in situations who necessitating hemodynamic solidity all over the surgery, as only transient tachycardia and hypotension were recorded Aim of work Using high doses of mivacurium can provide accepted condition of emergency intubation within favorable time - monitoring hemodynamics changes during and after intubation, time of recovery from high doses of muscle relaxant
Interventions
emergence modified sequence intubation
Sponsors
Al-Azhar University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Masking description
double blind
Intervention model description
prospective randomized double blind
Eligibility
Sex/Gender
ALL
Age
20 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* 20-60 year old patients. * American society of anaesthesia (ASA) 1 and 2. * Emergency surgery.
Exclusion criteria
* Refusal. * allergy. * neuromuscular disease. * Suspected desaturation. * Severe cardiac disease. * Severe pulmonary disease.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Intubation conditions during RSI. | 3 months | Jaw relaxation or ease blade insertion was graded as easy (3), moderate (2), difficult (1) and impossible (0). Vocal cord positions were ranked as abducted (3), moving (2), closing (1) and closed (0). Response to intubation was graded as no movement (3), slight diaphragmatic movement (2), mild coughing (1) and severe coughing or bucking (0). The total scores of the three variables were rated as excellent (8-9), good (6-7), fair (3-5) and poor (0-2). Good and excellent intubating conditions were considered 'clinically acceptable'. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| change in heart rate beat/minute: | 12 weeks | * pre-induction. * every 1 minute for 5 minutes after intubation |
| change in mean arterial bood pressure (MAP) mmHg/minute: | 12 weeks | * pre-induction. * every 1 minute for 5 minutes after intubating |
| time/minute to T1 recovery monitoring | 12 weeks | by train-of-four (TOF) every 5 minutes until one twitch of TOF |
Countries
Egypt
Contacts
Primary Contactismail m ahmed, professor
Outcome results
None listed