SummaryA double-blind trial of the effect of droperidol on the incidence of nausea and vomiting in patients using patient-controlled analgesia was carried out in 60 healthy women undergoing abdominal hysterectomy. After a standard anaesthetic including droperidol 2.5 mg as a prophylactic antiemetic, patients were randomly allocated to receive postoperative patient-controlled analgesia with either morphine alone ( 2 mg.ml-') or morphine ( 2 mg.rn1-') with droperidol (0.2 mg.ml-')

A 41-year-old male with insulin-dependent diabetes mellitus was admitted for an elective arthroscopic release of adhesive capsulitis of his left shoulder. At the end of the surgical procedure, he appeared to regain consciousness but then became unresponsive at the time of tracheal extubation after a violent bout of coughing, developing bilateral up-going plantar responses, decorticate posturing and abnormal pupillary reflexes. He was transferred to the intensive care unit. The following day, the patient made a full neurological recovery. Contrast echocardiography, performed using agitated saline delivered through a femoral venous line, revealed a large patent foramen ovale with evidence of right to left shunting. In the absence of risk factors for air embolism, the clinical diagnosis was one of paradoxical embolism of venous thrombus resulting in brain stem ischaemia. The patient was commenced on life-long aspirin to minimise future embolic risk. A patent foramen ovale is necessary in the fetal circulation to sustain intrauterine life. In utero, placental oxygenated blood enters the right atrium via the inferior vena cava and is directed towards the flap valve of the foramen ovale by the eustachian valve, thus enabling blood to enter the systemic circulation. At birth, the decrease in right-sided cardiac pressures and pulmonary vascular resistance reverses the right to left atrial pressure gradient and causes the flap of the foramen ovale to close against the atrial septum. Fusion is normally complete by the age of 2 years. In cases of incomplete fusion, the foramen ovale is kept sealed by the left atrial to right atrial pressure gradient but may be pushed open if right atrial pressure increases and exceeds that of the left atrium [1,2]. A patent foramen ovale is thus a potential route for emboli arising from the venous system to enter the systemic arterial circulation, resulting in the syndrome of 'paradoxical embolism'. We describe the case of a patient who experienced a paradoxical embolism induced by coughing during tracheal extubation. Case ReportA 41-year-old male with known microvascular complications secondary to insulin-dependent diabetes mellitus was admitted for an elective arthroscopic release of adhesive capsulitis of his left shoulder that had failed to respond to extensive physiotherapy. His past medical history included treated hypertension, micro-albuminuria, bilateral proliferative diabetic retinopathy and left exudative maculopathy with previous extensive panretinal photocoagulation. He had dyslipidaemia, drank alcohol occasionally and was a life-long non-smoker. Overall glycaemic control was good, but he had had several hospital admissions with symptomatic hypoglycaemia. Current medication included insulin, ramipril and over-the-counter analgesics.Six months previously, he had successfully undergone an elective arthroscopic release of his right shoulder with an excellent functional result. On this occasion, the general anaesthetic technique included fentanyl, propofol, atracurium and morphine...

A survey was undertaken to assess the incidence of thiabendazole resistance in field populations of H. contortus in sheep flocks on 40 farms distributed throughout the sheep grazing area of the northern tablelands of New South Wales. Treatment with thiabendazole at 66 mg/kg reduced H. contortus ova output by 96-100% in 18 flocks while in the remaining 22 there was a range of responses down to levels where the anthelmintic was without apparent effect. Factors which may contribute to the high incidence of anthelmintic resistance are discussed and the possibility of widespread resistance occurring in other sheep raising areas is considered.

No abstract

No abstract