Traumatic haemopericardium is an uncommon but life threatening condition. It is usually caused by penetrating cardiac injuries or cardiac rupture from blunt chest trauma. We report haemopericardium and cardiac tamponade in a young girl after blunt abdominal trauma. She presented with mild upper abdominal pain, tachycardia and hypotension having been kicked in the abdomen by a horse. No damage was found at laparotomy and she remained haemodynamically unstable. Further investigation found cardiac tamponade and haemopericardium. This was managed by insertion of a pericardial drain using transthoracic echocardiogram guidance, with later drainage in the operating theatre using guidance with a transoesophageal echocardiogram.

Myasthenia gravis is an uncommon autoimmune disease resulting in destruction of the postsynaptic nicotinic receptors at the neuromuscular junction. We describe a 43-yr-old, 95 kg patient who presented for elective laparoscopic cholecystectomy. She was given vecuronium 10 mg to facilitate tracheal intubation. At the end of the procedure the patient could not maintain adequate spontaneous ventilation despite administration of two doses of neostigmine 2.5 mg. Subsequent investigation led to a diagnosis of myasthenia gravis. We discuss the investigation, diagnosis, and subsequent management of such a patient and emphasize that tactile estimation of the train-of-four ratio is not a reliable indicator of adequate recovery of neuromuscular function.

propofol TCI was reduced to 3 mg ml 21. However, this information was not included in the Methods section of our article. In contrast, however, BIS was relatively low at 3 mg ml 21 of TCI. Although the TCI system does not predict plasma propofol concentration completely, a BIS monitor can be used during general anaesthesia. Remifentanil, however, affects the EEG characteristics during propofol anaesthesia. 2 Therefore, we also wanted to know how remifentanil affects BIS per se during propofol anaesthesia. Unexpectedly, our findings indicate the possibility that BIS does not reflect the actual plasma propofol concentration when co-administered with remifentanil. Thus, anaesthetic depth management using propofol TCI with remifentanil co-administration may be complicated, even when surgical stimulation is absent. Because remifentanil is used under surgical stimuli in a clinical setting, we think that further studies are necessary to clarify the effect of remifentanil on plasma propofol concentration or BIS during surgical stimulation. We cannot say whether presenting TCI is acceptable in scientific journals, but we believe that our findings are important for readers, especially those who use propofol TCI clinically.