Propofol Mivacurium

TIVA has become feasible thanks to the introduction of agents with a suitably short duration of action, including the injectable anesthetics propofol and etomidate, the analgesics alfentanil und remifentanil, and the muscle relaxant mivacurium. These drugs are eliminated within minutes after being adminster-ed, irrespective of the duration of anesthesia. 

Fentanyl, ketamine, midazolam, > propofol, thiopental Depolarizing succinylcholine Nondepolarizing atracurium, mivacurium, tubocurarine... 

The inhalational anaesthetics increase the effects of the neuromuscular blockers to differing extents, but nitrous oxide appears not to interact significantly. Ketamine has been reported to potentiate the effects of atracurium. Propofol does not appear to interact with mivacurium or vecuronium. Xenon is reported not to interact with mivacurium or rocuronium, and has less effect than sevoflurane on vecuronium neuromuscular blockade. Bradycardia has been seen in patients given vecuronium with eto-midate or thiopental. Propofol can cause serious bradycardia if it is given with suxamethonium (succinylcholine) without adequate antimuscarinic premedication, and asystole has been seen when fentanyl, propofol and suxamethonium were given sequentially. 

The original formulation of propofol in Cremophor was found to increase the blockade due to vecuronium, but the more recent formulation in soybean oil and egg phosphatide has been found in an extensive study not to interact with vecuronium." Propofol also appears not to interact with mivacurium. ... 

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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