The clinical and electromyographic effects ofisoflurane were studied in eight myasthenic patients undergoing trans-sternal thymectomy. After inhalational induction of anaesthesia, intubating and operating conditions were good. Recovery from anaesthesia was rapid with minimal postoperative residual muscle weakness or respiratory depression. All patients were extubated within the first postoperative hour. Integrated electromyographic monitoring of the train-offour response of adductor pollicis demonstrated that myasthenics are more sensitive than nonmyasthenics to the neuromuscular depressant effects of isoflurane. Recovery of the integrated electromyographic response was incomplete despite a satisfactory clinical recovery.

In a single-blind controlled study, forty children with congenital heart disease were premedicated with oral trimeprazine 3 mg/kg and either intramuscular morphine 0.1 mg/kg or oral ketamine 10 mg/kg. Cardiovascular and respiratory effects of premedication and degree of sedation induced were similar in the two groups of patients. Oral ketamine is a safe and effective premedicant in this group of patients.

Physical or chemical interactions between enteral feeding solutions and drugs are uncommon but may lead to relatively serious complications. We report a case of total oesophageal obstruction in a patient receiving Sucralfate suspension and Ensure Plus enteral feed.

Congenital antithrombin III (AT-Ill) deficiency is an inherited autosomal dominant condition with a prevalence of 1 in 2,000 to 20,000. Affected individuals are predisposed to venous thromboembolism which is commonly precipitated by pregnancy, surgery or infection'. Untreated, AT-Ill deficiency in pregnancy is associated with an extremely high risk of thrombosis (700/0)2. The various regimens of antithrombosis prophylaxis for AT-Ill deficiency in pregnancy have implications for the provision of anaesthesia and regional analgesia.