# Assessing the Optimal Dose of Mivacurium for Modified Rapid Sequence Intubation in Emergency Surgical Settings: A Randomized, Double-Blind Trial

## TL;DR

This study finds that a higher dose of mivacurium improves intubation in emergency surgery but delays recovery.

## Contribution

The study identifies 0.4 mg/kg as the optimal mivacurium dose for modified rapid sequence intubation in emergency settings.

## Key findings

- A 0.4 mg/kg dose of mivacurium provides better intubation conditions and faster muscle relaxation onset.
- The 0.4 mg/kg dose is associated with significantly lower blood pressure and longer recovery time.
- Higher mivacurium doses improve outcomes in modified rapid sequence intubation for emergency surgery.

## Abstract

Modified rapid sequence intubation (RSI) is crucial in emergency surgery, particularly for patients with a full stomach, as it allows for the administration of general anesthesia (GA).

This work aimed to evaluate mivacurium effectiveness and optimal dose in modified RSI.

This randomized double-blind study involved 100 patients, aged between 20 - 60 years, of both sexes, with the American Society of Anesthesiologists physical status classification of I - III, who were undergoing emergency surgery under GA. Patients were randomized into two equal groups and received mivacurium in a dose of 0.3 mg/kg in group M1 or 0.4 mg/kg in group muscarinic-2 (M2).

Intubating conditions were significantly better in group M2 than in group M1. The onset of adequate muscle relaxation was significantly earlier in group M2 than in group M1 (P < 0.001). At the third minute, mean arterial blood pressure recordings were significantly lower in group M2 (P = 0.04) than in group M1. The recovery time was significantly longer in group M2 than in group M1 (P < 0.001).

Mivacurium in a 0.4 mg/kg dose resulted in more favorable intubating conditions during RSI and a more profound, earlier onset of muscle relaxation, but with a longer recovery time compared to the 0.3 mg/kg dose.