Use of mivacurium during laparoscopic surgery: Effect of reversal drugs on postoperative recovery

We studied the influence of mivacurium on the recovery profile following outpatient laparoscopic tubal ligation in 60 healthy nonpregnant women. After administration of midazolam 2 mg intravenously (IV), anesthesia was induced with fentanyl, 2 μg/kg, and thiopental, 4 mg/kg, IV. When the patient became unresponsive (loss of eyelid reflex), either succinylcholine 1 mg/kg, IV (Group I), or mivacurium 0.2 mg/kg, IV (Groups II and III), was administered to facilitate tracheal intubation. Anesthesia was maintained with isoflurane (0.5%-2% inspired concentration) in combination with 67% N₂O in oxygen. Muscle relaxation was maintained in all three groups with intermittent bolus doses of mivacurium, 2-4 mg, IV. In Group III, residual neuromuscular block was reversed with a combination of neostigmine, 2.5 mg, and glycopyrrolate, 0.5 mg, IV, at the end of the operation. In the postanesthesia care unit (PACU), patients in Group III had a significantly increased incidence of postoperative nausea and vomiting compared to Group II. The use of succinylcholine (versus mivacurium) was also associated with more frequent postoperative nausea and vomiting. However, these emetic sequelae did not delay postoperative recovery times. In addition, a comparable number of patients in each treatment group required analgesic medication for postoperative pain. Although patients who received succinylcholine complained of significantly more neck pain during the 24-h period after discharge, nausea, vomiting, and shoulder pain were similar in all three groups during this period. We conclude that neostigmine and glycopyrrolate may contribute to the development of postoperative emesis when used for reversal of residual neuromuscular block. The use of mivacurium without reversal drugs was associated with a decreased incidence of nausea and vomiting in the PACU.