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Mivacurium is a benzylisoquinolone, choline-like, non-depolarizing muscle relaxant. Its onset of action is similar to that of atracurium but its duration of action is shorter (approximately 10-15 minutes). Mivacurium is metabolized by plasma cholinesterases at approximately 70% of the rate of metabolism of suxamethonium 1 . Deficiency or abnormality of plasma cholinesterase may cause the duration of action of both suxamethonium 2,3 and mivacurium 2,4,5,6 to be greatly prolonged. We describe a case of prolonged mivacurium paralysis after day surgery. Laboratory investigations showed a genetic tendency toward abnormal cholinesterase levels, but markedly depressed cholinesterase activity was suggestive of additional acquired causes. This patient had a history of liver disease, malnutrition and anticholinesterase use, which we believe were the most significant factors involved.

Audiological findings in patients with histories of noise exposure were examined. 27 patients (1.5%) were found to have audiograms with a double-notch configuration. Information from their occupational history, medical history, and audiological findings was gathered and analysed. Their results were compared with those of 50 random samples of patients without the double-notch audiogram. Analyses suggest that the low frequency notch is probably also caused by noise damage. The low incidence of double-notch audiogram reflects the small proportion of people with susceptibility to noise damage at the 500 Hz to 1 kHz region in addition to the 3 to 6 kHz region. This double-notch configuration could be exaggerated possibly by the release from inhibition by damaged hair cells.