Glycopyrrolate 5 and 7.5 micrograms kg-1 and atropine 10 and 15 micrograms kg-1 were studied in 80 paediatric patients to assess more fully the dose of glycopyrrolate required for adequate prevention of the oculocardiac reflex. A dose-related improvement in protection from this reflex was seen with both drugs, but neither drug prevented reductions in heart rate in every patient. A nodal rhythm was the most common arrhythmia observed with both drugs. In the doses used, no adverse effects were noted and no further anticholinergic treatment was required during muscle traction. Higher doses may be associated with an increase in side-effects with more pronounced dryness of the mouth and tachycardia and, with atropine, a greater likelihood of the production of the "central anticholinergic syndrome".

A 61-year-old man with severe factor XI deficiency presented for coronary artery bypass surgery. The clotting deficiency was corrected preoperatively with factor XI concentrate. Surgery resulted in severe postoperative haemorrhage of 55 liters of blood. This was managed successfully with a cell saver device (Haemonetics). Repeated platelet transfusions were ineffective in correcting the platelet dysfunction. The severe haemorrhage stopped suddenly after the infusion of 4 units of fresh blood. The case demonstrates how fresh blood can be useful in the management of severe haemorrhage after massive blood transfusion.

No abstract

Oxygenated crystalloid cardioplegia was found not to produce better cardioprotection than blood or crystalloid cardioplegia, as assessed by myoglobin and creatine kinase MB (CPK-MB) isoenzyme, in patients undergoing coronary artery surgery. Myoglobin and CPK-MB levels were found to peak at 1 and 3 h, respectively, following release of the aortic cross-clamp. There was a good correlation between peak myoglobin and CPK-MB levels. CPK-MB of non-cardiac origin was found to represent a substantial proportion of total CPK-MB 4 h after the release of the aortic cross-clamp.