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SUMMARY An hour after a 220 V electric shock a patient who was susceptible to mild vasovagal symptoms in response to emotional stress had a severe episode of cardiac arrest in response to insertion of a cannula. No The potential lethal effect of autonomic-reactions when there is electrical instability in the heart has been described in patients with ischaemic heart disease and in animal experiments.45 We report a patient who fainted soon after a 220 V electric shock. About an hour later sinus arrest developed seconds after the insertion of an intravenous cannula.

Muscle function tests of the triceps brachii muscle were performed before operation and on the third postoperative day in ten patients undergoing elective cholecystectomy. Electromyograms (EMGs) were recorded by surface electrodes during sustained isotonic and isometric muscle contraction with a constant force of 20 per cent of the preoperative maximal voluntary contraction. Root-mean-square of the EMG was calculated together with the neuromuscular efficiency and measures of the fatiguability. These parameters were compared with changes in the simultaneously measured serum phosphate concentrations. Mean (s.e.m.) neuromuscular efficiency measured after 32-40 s of muscle contraction decreased 14(5) per cent after operation (P less than 0.01), whereas the mean fatiguability of the muscle was unchanged. Mean serum phosphate concentration was 0.87(0.06) mmol/l before operation and 0.79(0.06) mmol/l 3 days after the operation (P greater than 0.05). Two patients developed severe postoperative hypophosphataemia (serum phosphate concentration less than 0.50 mmol/l). Postoperative muscle function deterioration was not associated with changes in the serum phosphate level (P greater than 0.10; r = 0.03). We conclude that patients undergoing cholecystectomy develop postoperative deterioration in skeletal muscle function, which is not associated with serum phosphate concentration.