Tramadol-induced hyponatraemia following unicompartmental knee replacement surgery.

We report a case of postoperative hyponatraemia following routine knee surgery, followed by a subsequent, less severe, episode after identical surgery on the contralateral knee. On each occasion the patient had been given the weak opioid tramadol for postoperative pain relief. Through its effects on serotonergic neurotransmission in the central nervous system, we hypothesise that tramadol may have been directly involved in this patient's biochemical disorder.

The use of recombinant activated factor VII in the control of haemorrhage following blunt pelvic trauma.

This article reports two cases of severe blunt pelvic trauma associated with road traffic accidents, where the patients developed significant bleeding and haemodynamic instability, poorly responsive to conventional management. Both patients required massive transfusion of blood products with a resultant dilutional coagulopathy. In each case, a single dose of recombinant activated factor VII (rFVIIa) was used to achieve haemostatic control, with a subsequent decrease in blood product requirements and improvement in haemoglobin concentration and clotting profile.