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Potentiation of Mivacurium by Rocuronium Is Age‐ and Time‐Dependent: A Study in Children, Adolescents, and Young and Elderly Adults

Potentiation occurs when the steroidal muscle relaxant, rocuronium, is coadministered with the benzylisoquinolinium relaxant, mivacurium. The effect of time and age on this interaction was evaluated in four predetermined groups: children, adolescents, young adults, and elderly adults (15 per group) by monitoring the ulnar nerve—evoked force of contraction of the adductor pollicis (twitch response). During recovery from paralysis induced by 600 μg/kg of rocuronium, an infusion of mivacurium was started and maintained for at least 90 minutes to retain the twitch response at 1% to 9% of baseline tension (95 ± 4% paralysis). Rocuronium at 600 μg/kg induced greater than 95% paralysis in 57 of the 60 patients within 2.2 ± 0.4 (mean ± SE) minutes. The period of recovery from rocuronium‐induced paralysis to 5% of baseline twitch height was longest in the elderly (30.1 ± 2.9 minutes) and shortest in the adolescents (16.5 ± 2.4 minutes). The mivacurium infusion requirements to maintain 95 ± 4% paralysis was highest in children and progressively increased with time. In young and elderly adults, the infusion rates remained lower than that of children and did not change with time. The incidence of satisfactory spontaneous recovery within 20 minutes (train‐of‐four ratio >75%) was the highest in children, followed by adolescents and young adults, and was least in the elderly. The residual neuromuscular effect of rocuronium on the subsequent mivacurium infusion was most pronounced in the elderly, followed by young adults, then adolescents, and was least in children.