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1.
Acta Anaesthesiol Scand ; 63(5): 564-575, 2019 05.
Article in English | MEDLINE | ID: mdl-30548256

ABSTRACT

BACKGROUND: Mivacurium is a short-acting non-depolarizing muscle relaxant, which is hydrolyzed by butyrylcholinesterase. The neuromuscular block (NMB) can be antagonized with cholinesterase inhibitors (CHEI), but the short duration of action of mivacurium questions the need. This systematic review evaluated if the use of CHEIs (neostigmine, pyridostigmine or edrophonium) facilitates reversal of mivacurium-induced NMB. METHOD: Randomized controlled trials and crossover-studies comparing spontaneous recovery with CHEI reversal in patients with mivacurium-induced NMB, assessed with quantitative neuromuscular monitoring, were included. Mean time from injection of the CHEI or allowing of spontaneous recovery to an endpoint representing full recovery was used as outcome. First response to train-of-four nerve stimulation (T1 ) described the level of NMB for administration of the CHEI. Moderate NMB refers to T1  ≥ 5% and deeper NMB refers to T1  < 5%. Systematic critical appraisal was performed using the Scottish Intercollegiate Guidelines Network guidelines. Overall quality assessment was done using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Sixteen studies with data from 546 patients were included. Low quality of evidence was found that neostigmine and edrophonium administered at moderate NMB accelerated recovery with up to approximately 5.5-6.5 and 6.5-9.0 minutes, respectively. At deeper NMB only edrophonium accelerated recovery. The effect of neostigmine was not clarified at deeper mivacurium-induced NMB. No studies with reversal by pyridostigmine were identified. CONCLUSION: Low quality of evidence supports that neostigmine and edrophonium accelerate the recovery of mivacurium-induced NMB with 5-6.5 and 6-9.0 minutes respectively, when administered at moderate NMB. At deeper NMB only edrophonium accelerated the recovery.


Subject(s)
Cholinesterase Inhibitors/pharmacology , Mivacurium/pharmacology , Neuromuscular Blockade , Edrophonium/pharmacology , Humans , Neostigmine/pharmacology , Randomized Controlled Trials as Topic , Time Factors
2.
Ugeskr Laeger ; 178(50)2016 Dec 12.
Article in Danish | MEDLINE | ID: mdl-27966416

ABSTRACT

INTRODUCTION: To study the effect on mold formation when leaving the first slice in situ in white sliced bread (WSB). MATERIAL AND METHODS: We randomized 20 bags of WSB from a single production batch to either have the first slice removed or left in situ and compared mold formation and dryness on day ten. We removed two slices of bread from each bag daily and used blinded outcome assessors. RESULTS: We found mold in seven vs. six bags in the groups (p = 1.00). Results on dryness were inconsistent. The study may have been underpowered. CONCLUSION: Leaving the end slice in situ may not affect mold formation in WSB.


Subject(s)
Bread/microbiology , Fungi/growth & development
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