The analgesic efficacy and safety of tramadol and morphine were compared in a double-blind, randomized study of 150 female patients after gynecologic surgery. As required, patients could receive up to three intravenous doses of either 50 mg of tramadol or 5 mg of morphine within a period of 6 h. Pain intensity (verbal response score) was recorded before injection and at 0.5, 1, 2, 3, 5, and 6 h after the initial dose; at these times, pain relief was also assessed. Oxygen saturation was monitored continuously by pulse oximetry for at least 30 min after each injection. In 13.3% of the morphine group (but in none of the tramadol group) transcutaneous pulse oxygen saturation decreased to less than 86%; in 50% of these patients the decrease occurred after only the first 5 mg of morphine. Both drugs produced acceptable analgesia, and there were no clinically significant adverse events. In demonstrating the absence of clinically relevant respiratory depression with tramadol, we underline its safety for postoperative pain relief.

This report describes a 35-year-old 40 week pregnant woman who was hospitalized with a diagnosis of acute anteroseptal myocardial infarction. She sustained another, infero-posterior, infarction 4 days later. Coronary arteriography performed after successful Cesearean section displayed primary dissections of the right as well as both left coronary arteries. Her subsequent clinical course was uneventful with medical therapy. This patient is the first non-surgically treated survivor of peripartal spontaneous coronary artery dissection with a myocardial infarction prior to delivery.

We present an automatic closed circuit anaesthesia ventilator designed for routine clinical use. The ventilator combines the benefits of high flow systems and true closed circuits, without their disadvantages. The system can be used with any Fi0 2 , with air or nitrous oxide as carrier gas. Servo controlled delivery of modern volatile anaesthetics is regulated on endtidal value. The time constant for increase or decrease of concentrations is only a few minutes. There is no need to open the system at any time, nor is it necessary to increase the fresh gas flow. An automatic flush procedure prevents accumulation of unwanted gases. Operation is as easy as contemporary non-closed circuit ventilators. With this machine, closed circuit anaesthesia is possible from the beginning to the end of the procedure.

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