A case of cardiac arrest during anaesthesia for appendicectomy is presented. The diagnosis was uncertain and seemed to lie between malignant, hypertonic hyperpyrexia and endotoxic shock, but the features were not typical of either syndrome. This case presented a problem in diagnosis, which was not resolved by postmortem examination. CASE REPORT A 33-year-old Malay soldier was admitted complaining of vague abdominal pain of 2-3 days' duration. He had had one previous admission 8 months previously for a similar pain, which resolved rapidly. Otherwise he had had no serious illnesses or operations and his family history was unremarkable. On examination he was a fit-looking man of normal physique, weighing 120 lb. His temperature was 37.2 °C and diffuse abdominal tenderness was noted. Chest Xray was normal. After observation for 2 days, appendicectomy was proposed. He was premedicated with papaveretum 20 mg and hyoscine 0.4 mg, li hours before induction. Anaesthesia was induced at 14.00 hours with thiopentone 400 mg and suxamethonium bromide (Brevidil) 20 mg. A cuffed, oral, endotracheal tube was passed. Anaesthesia was maintained with nitrous oxide, 33 per cent oxygen and 0.5 per cent halothane, ventilation being controlled using a Manley ventilator, at a tidal volume of 500 ml, and a minute volume of 10 L/min. Relaxation was provided by repeated doses of suxamethonium bromide to a total of 160 mg. As soon as anaesthesia was established, a mass was palpable in the right iliac fossa and the operation proved rather more difficult than had been anticipated, the appendix being inflamed, friable and adherent, and required considerable dissection. Accordingly an intravenous infusion of dextrose-saline was set up and a Ryle's tube passed. At no time was there any abnormal reaction to suxamethonium and the patients jaw and limbs remained relaxed during these manoeuvres. The patient was noted to be hot and the question of postoperative antibiotics was discussed. His pre-operative temperature had been 37.1 *C and he had not previously received any antibiotics. The theatre was airconditioned. Pulse and blood pressure remained satisfactory. At 15.45 the last dose of suxamethonium bromide was given and anaesthesia was thereafter maintained with nitrous oxide, oxygen and 0.5 per cent halothane while the abdomen was closed. At 16.00 hours, after suture of the peritoneum, the pulse suddenly became irregular and rigidity of the limbs was noticed. At 16.05, in spite of pulmonary ventilation with 100 per cent oxygen, the pulse ceased and external cardiac massage

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