Our results suggest that norepinephrine can be used safely in the treatment of severe septic shock states. Mean arterial pressure and glomerular filtration rate improved markedly without deleterious effects on CI, O2AVI and VO2I.

Increased sensitivity to rocuronium and atracurium in mitochondrial myopathyPurpose: To describe the prolonged effect of the intermediate-acting, non-depolarising neuromuscular blocking agents rocuronium and atracurium in a 29-yr-old apparently healthy woman. Clinical features: Because of abdominal pain the patient was scheduled for explorativelaparoscopic pelvic examination. General anaesthesia was induced with fentanyl, midazolam and propofol. Muscle relaxation was achieved with 0.6 mg.kg-' rocuronium. Anaesthesia was maintained with nitrous oxide and propofol. Two Hz train-of-four stimulation every 15 sec evoked no twitch responses until 60 min after rocuronium. Further relaxation was achieved with 0.075 mg.kg-' atracurium after which twitch responses recurred after 45 min. Fifteen minutes later neuromuscular blockade was successfully reversed with atropine and neostigmine. The postanaesthetic course was uneventful. Because of the increased sensitivity to rocuronium and atracurium the patient was re-evaluated postoperatively. History revealed occasional double vision, fatigue, muscle cramps, stiffness and myoglobinuria. Clinical neurological examination showed ptosis, tremor, ataxia and bradydiadochokinesia. A standardised lactate stress testing on a bicycle was pathological and, after muscle biopsy, the diagnosis of mitochondrial myopathy was established. Conclusion: An increased sensitivity to rocuronium and atracurium may occur in patients with mitochondrial myopathy. In these patients appropriate dosing of muscle relaxants and adequate monitoring of the neuromuscular blockade are required. If an increased sensitivity to rocuronium and atracurium occurs in an apparently healthy subject, further neurological investigations should follow.Objectif : D&rire I'effet prolong~ des inhibiteurs neuromusculaires non d~polarisants ~ action interm~diaire, rocuronium et atracurium, chez une femme de 29 ans apparemment en bonne sant~. Aspects cliniques : La patiente a 6t~ admise pour un examen laparoscopique exploratoire du bassin ~ la suite de douleurs abdominales. I'anesth&ie g~n&ale a ~t~ induite avec du fentanyl, du midazolam et du propofol. La relaxation musculaire a ~t~ obtenue avec 0,6 mg'kg ~ de rocuronium. I'anesth&ie a ~t~ maintenue avec du protoxyde d'azote et du propofol. Une stimulation de deux Hz en train-de-quatre ~ toutes les 15 secondes n'a pas d&lench~ de contraction musculaire avant 60 minutes suivant radministration du rocuronium. Une relaxation suppl6mentaire a ~t~ obtenue, avec 0,075 mg.kg -~ d'atracurium, apr~s laquelle les contractions musculaires ont reparu 45 minutes plus tard. Apr~s quinze minutes, le bloc neuromusculaire &ait renvers~ avec succ& avec ratropine et la n(.~ostigmine. I'~volution postanesth~sique a ~t~ sans complication. La patiente a ~t6 ~valu6e de nouveau apr& I'intervention ~ cause de la sensibilit~ accrue au rocuronium. I'histoire a r~v~l~ une diplopie occasionnelle, de la fatigue, des crampes musculaires, de la raideur et de la myoglobinurie. ~examen neurologique clinique a ...

Muscle biopsy and in vitro contracture tests for diagnosis of susceptibility to malignant hyperthermia (MH) were performed in two patients who had developed fever and severe myolysis during exercise. MH susceptibility was confirmed in one patient, but in the other, exercise-induced heat stroke proved to be the correct diagnosis. Clinical presentation and epidemiology of exercise-induced MH and its relation to the heat stroke syndrome are discussed.

Reoperation for abdominal sepsis frequently causes substantial hypotension, and is, thus, potentially harmful to the patient. Reoperative trauma may induce an early postoperative increase in interleukin-6 levels. Because this increase occurs before the development of hypotension, a relationship between the kinetics of this cytokine and the observed hemodynamic instability may be present.