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We report two cases of Jehovah's Witness patients who had massive bleeding after surgery. The first case was a 37-year-old woman who underwent an emergency cesarean section; the other was a 48-year-old man with chronic anemia who underwent removal of a large mass. After the operation, their Hb levels were nearly 3.1 g/dl. They were treated with blood conserving methods, divided into 3 periods (pre, post and operative). Both patients completely recovered uneventfully and were discharged on the 19th and 21st postoperative day.

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Background: This study was performed to evaluate the presynaptic effects of depolarizing neuromuscular blocking drugs by using slow and fast frequencies of indirect stimulation on partial twitch depression in vitro.Methods: A rat phrenic nerve hemidiaphragm was dissected and was mounted in an organ bath containing an oxygenated Krebs solution. The phrenic nerve was stimulated supramaximally and the twitch response (0.1 Hz) was stabilized for at least 30 minutes. T200/T1 ratio (twitch height of the 200th stimuli divided by that of the first stimuli) at frequencies of 0.2, 0.5, 1.0, and 2.0 Hz using a drug concentration which provided approximately 20% twitch depression at 0.1 Hz was calculated. To compare T200/T1 ratios with TOF ratios, a 2.0 Hz TOF response was measured immediately after the 200th stimuli at either frequency of stimulation.Results: T200/T1 ratios produced by succinylcholine (SCC) and decamethonium (C10) were located between α-bungarotoxin (ABX) and hexamethonium (C6), however, significant differences among the four drugs were found at 2.0 Hz. The propensity for a decrease in T200/T1 ratios at 2.0 Hz might differ from this study: C6 ＞ C10 ＞ SCC ＞ ABX. T200/T1 ratios at 2.0 Hz were not different from TOF ratios.Conclusions: It is concluded that small doses of C10 have a greater presynaptic activity than that of SCC, when the observed effects in this study were compared with the result of ABX acting predominantly at postsynaptic receptors and C6 acting predominantly at presynaptic receptors.