GasGasGas - Anaesthetic Science for Anaesthesia! Mivacurium + mischief with plasma cholinesterase
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Feb 6, 2026 A deep dive into mivacurium’s place among neuromuscular blockers and its unique isomeric chemistry. Discussion of its pharmacodynamics, dosing and typical onset. Exploration of histamine-related side effects and plasma cholinesterase metabolism. Clinical scenarios about prolonged paralysis, genetic enzyme variants and practical management options.
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Rare Clinical Use Recalled
- Dr Gas Lurks recalls using mivacurium once for a 14-year-old child needing intubation for ENT surgery.
- The rare usage highlights how uncommon mivacurium is in current practice.
Mechanism, Dosing And Onset
- Mivacurium is a competitive non-depolarizing blocker at nicotinic receptors producing flaccid paralysis.
- ED95 is ~0.08 mg/kg (3.8 min onset), common induction dose 0.2 mg/kg with ~2 min onset.
Practical Dosing For Clinical Use
- Give 0.2 mg/kg IV for induction and consider a half-dose repeat for maintenance to achieve ~15 minutes of paralysis.
- Expect a longer duration than suxamethonium but shorter than atracurium or rocuronium.