Mivacurium: a Review

Mivacurium is a short-acting non-depolarizing neuromuscular-blocking agent (NMBA) which has recently been re-released onto the US market. This review provides a brief overview about the pharmacology of mivacurium and discusses its use in recent clinical practice.

Mivacurium has been reported to be especially useful in the pediatric population, especially for shorter cases, and infusions can be used for longer cases without inducing tachyphylaxis. As it is rapidly metabolized by pseudocholinesterase (PChE), mivacurium does usually not require a specific reversal agent to offset its actions at the end of surgery. Especially for use in short cases, this makes it a potentially advantageous alternative to the use of other NMBA. However, deficiencies in PChE as well as old age and some drug interactions can be associated with prolonged neuromuscular blockade. The rapid administration of higher doses may provoke significant histamine release leading to hemodynamic compromise.

Despite other NMBA being available on the market and its side effects, mivacurium may still be a useful agent in short cases, particularly in the pediatric population.