An improved survival rate was observed only among medical patients admitted to the ICU with mandatory continuous access to a consultant intensivist, despite the presence of greater disease severity in the population admitted to this unit.

in six healthy volunteers, integrated evoked electromyography (IEEMG) measured in response to ulnar nerve stimulation was correlated with respiratory function -tidal volume (VT), forced vital capacity ( FVC ), forced expiratory volume in one second (FEVt), maximum negative inspiratory pressure (NIP) Neuromuscular blocking agents are routinely utilized in general anaesthesia to facilitate tracheal intubation and provide adequate relaxation for surgical procedures. Because neuromuscular weakness may lead to hypoventilation and/or upper airway obstruction, not infrequent complications observed in the recovery room, it is important that any residual neuromuscular blockade following a surgical procedure be detected and adequately reversed. J.2 Electrical stimulation of a peripheral nerve with subsequent observation of the mechanical or electromyographic response of its innervated muscle helps to determine the degree of neuromuscular blockade during administration of muscle relaxants. 3-6 Furthermore, correlations between train-of-four and tetanic stimulation and variables of respiratory function have been established. 7-9 However, an inexpensive and reliable, quantitative monitor of mechanical twitch response is as yet CAN J ANAESTH 1990/ 37: 3/pp. 307-12

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REFERENCES1. Takasaki M, Takahasi T. Respiratory function during cervical and thoracic extradural analgesia in patients with normal lungs. Br

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This is a rare case of broncho-pleuropericardial fistula in a 12-year-old female who presented with fever, painful joint swelling, and pleural and pericardial effusion secondary to disseminated methicillin-sensitive Staphylococcus aureus infection. The pleural and pericardial effusion were drained, however, air leak was observed from both tubes and was synchronous with mechanical inspiration. A broncho-pleuropericardial fistula was suspected and confirmed with computed tomography. This case report demonstrated that disseminated S. aureus bacteremia could result in broncho-pleuropericardial fistula. The ability of disseminated staphylococcal infection to produce pnemopericardium should be added to the list of other complications associated with disseminated staphylococcal sepsis.

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