Prolonged paralysis following suxamethonium and the use of neostigmine.

A case of prolonged neuromuscular block following the administration of suxamethonium is reported. Three hours after administration of suxamethonium, a well defined, recovering phase II block was demonstrated with a T4:T1 ratio of 0.25, and neostigmine was administered. Although the T4:T1 ratio was improved to 0.9, T1 remained at 25% of control, and significant paralysis persisted which responded to administration of cholinesterase. It is concluded that neuromuscular monitoring cannot reliably predict reversibility in such cases and that, even after 3 h, antagonism of prolonged suxamethonium block should commence with cholinesterase, followed by neostigmine if necessary.

Rupture of the head of the pancreas by blunt trauma. A case report.

An unusual injury to the head of the pancreas is described. The various surgical options are discussed and the literature is reviewed. The Roux-en-Y pancreaticojejunostomy for a major isolated rupture of the head of the pancreas is considered to be the operation of choice.