Figure 13-22 Metabolism of mivacurium by butyrylcholinesterase. The reaction occurs at about 70% to 88% of the rate of succinylcholine in vitro. The metabolites are inactive and carry positive charges, thus suggesting minimal central nervous system entry. (Redrawn from Savarese JJ, Ali HH, Basta SJ, et al: The clinical neuromuscular pharmacology of mivacurium chloride [BW B1090U]. A short-acting nondepolarizing ester neuromuscular blocking drug. Anesthesiology 68:723–732, 1988.)