Despite the possibility of a modest reduction in the risk of massive bleeding, the strong and consistent negative mortality trend associated with aprotinin, as compared with the lysine analogues, precludes its use in high-risk cardiac surgery. (Current Controlled Trials number, ISRCTN15166455 [controlled-trials.com].).

Myocarditis and pericarditis may constitute adverse reactions of mRNA coronavirus disease 2019 (COVID‐19) vaccines. This study aimed to document these reactions and to assess the association with patient sex and age. This is as an observational retrospective study using a case–non‐case design (also called disproportionality study) on inflammatory heart reactions reported with mRNA COVID‐19 vaccines within the World Health Organization (WHO) global safety database (VigiBase), up to June 30, 2021. Results are expressed using reporting odds ratios (RORs) and their 95% confidence interval (95% CI). Of 716,576 reports related to mRNA COVID‐19 vaccines, 2,277 were cases of inflammatory heart reactions, including 1241 (55%) myocarditis and 851 (37%) pericarditis. The main age group was 18–29 years (704, 31%), and mostly male patients (1,555, 68%). Pericarditis onset was delayed compared with myocarditis with a median time to onset of 8 (3–21) vs. 3 (2–6) days, respectively (P = 0.001). Regarding myocarditis, an important disproportionate reporting was observed in adolescents (ROR, 22.3, 95% CI 19.2–25.9) and in 18–29 years old (ROR, 6.6, 95% CI 5.9–7.5) compared with older patients, as well as in male patients (ROR, 9.4, 95% CI 8.3–10.6). Reporting rate of myocarditis was increased in young adults and adolescents. Inflammatory heart reactions may rarely occur shortly following mRNA COVID‐19 vaccination. Although an important disproportionate reporting of myocarditis was observed among adolescents and young adults, particularly in male patients, reporting rates support a very rare risk, that does not seem to compromise the largely positive benefit‐risk balance of these vaccines. Furthermore, this study confirmed the value of disproportionality analyses for estimation of relative risks among subgroups of patients.

No abstract

No abstract

Cyclosporine is a new immunosuppressive agent that has done much to improve outcome in transplant surgery, decreasing the incidence of graft rejection and increasing graft survival. 1 Increasing numbers of patients who are receiving cyclosporine therapy following organ transplantation are presenting for anaesthesia. As well, protocols for organ transplantation often call for preoperative and intraoperative administration of cyclosporine.The intravenous preparation of cyclosporine is dissolved in an ethanol-cremophor vehicle. Interactions between cremophor and muscle relaxants have been reported in man. z Interactions between both cremophor and cyelosporine and muscle relaxants have been reported in experimental animals. 3The following is a case report of a patient treated with cyelosporine who demonstrated prolonged muscle paralysis after administration of pancuronium during an operative procedure. Residual muscle paralysis persisted in the postoperative period after reversal of pancuronium blockade. Case ReportA 54-year-old, 55 kg female was admitted to hospital with an incapacitating headache and was diagnosed as having a right posterior communicating artery anearysm. Craniotomy for the purpose of aneurysm clipping was scheduled. The patient had received a renal allograft two years previously for dialysis-dependant chronic renal failure secondary to chronic gtomerolonephritis. Immunesuppression was maintained with azathioprine 100 mg daily, cyclosporine 300 mg daily and prednisone 10 mg daily. Nifedipine 40 mg daily and furosemide 20 mg daily were prescribed for chronic hypertension. A smoking habit of one pack per day and thirty pack-years was noted.Preoperative evaluation revealed an agitated and confused middle-aged female. The right pupil was 1-1.5 mm larger than the left and both pupils were light-reactive. The neurological examination was otherwise normal. Blood pressure was 170/96 and heart rate 84. min -~ and regular. The chest was clear on auscultation. Results of laboratory studies revealed a haemoglobin of 104 g-L-~. Platelet count and coagulation studies were normal. The CAN J ANAESTH 1988 ? 35:3 f pp300-2