Mivacurium Isoflurane

Inhalation anesthetics potentiate the neuromuscular blocking action of mivacurium, as with other nondepolarizing relaxants. With isoflurane (3) and enflurane (18) the ED95 is reduced by about 25% and the duration of action is somewhat prolonged, although the extent of this is not clear. Halothane has much less of an effect (19 0). 

Choi WW, Mehta MP, Murray DJ, Sokoll MD, Forbes RB, Gergis SD, Abou-Donia M, Kirchner J. Neuromuscular and cardiovascular effects of mivacurium chloride in surgical patients receiving nitrous oxide-narcotic or nitrous oxide-isoflurane anaesthesia. Can J Anaesth 1989 36(6) 641-50. 

Clinically important, potentially hazardous interactions with aminoglycosides, cortisone, cyclopropane, enflurane, gentamicin, halothane, hydrocortisone, isoflurane, kanamycin, methoxyflurane, mivacurium, neomycin, piperacillin, prednisolone, prednisone, streptomycin, tobramycin... 

It has also been suggested that for mivacurium, higher plasma levels, especially of the potent trans-trans isomer, occur in the presence of isoflurane, and these could contribute to the enhanced neuromuscular blockade observed. ... 

Ledowski T, Wulf H, Ahrens K, Weindimayr-Goettel M, Kress H-G, Geldner G, Scholz J. Neuromuscular block and relative concentratiens of mivacurium isomera under isoflurane veraus propofol anaesthesia. EurJ Anaesfftesiol (2003) 20, 821-5. 

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