We have investigated the effects of pancuronium bromide (0.07 mg/kg body weight) on heart rate, mean arterial blood pressure, cardiac output and calculated total peripheral resistance in ten artificially ventilated patients, anaesthetized with 60 per cent nitrous oxide in oxygen plus phenoperidine (1 mg/15 kg body weight). End-tidal Pco 2 was maintained constant at 30 ±2 mm Hg. There was a marked and statistically significant increase of heart rate of about 25 per cent, accompanied by lesser, but still statistically significant, increases of cardiac output and mean arterial blood pressure. Total peripheral resistance was unchanged, suggesting that pancuronium has little ganglion-blocking activity. 65 68 60 76 75 Premedication (P/H mg) 15/0.4 15/0.4 15/0.4 20/0.4 20/0.4 Thiopentone (mg/kg) 4.6 3.7

Strongyloides hyperinfection syndrome is rarely described in immunocompetent individuals. We present a case of fatal Strongyloides hyperinfection syndrome, and a literature review identifying nine other cases occurring in immunocompetent individuals, highlighting the challenges of diagnosis and treatment in this setting. While overall mortality is lower compared to immunocompromised patients, fatal outcomes still occur. A high index of suspicion is required for early diagnosis and treatment.

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