Neonates are known to be sensitive to volatile anaesthetic agents which may lead to prolonged recovery. In this study, a remifentanil infusion was used in conjunction with an infusion of epidural ropivacaine and isoflurane anaesthesia for major abdominal surgery in small infants. This led to a short recovery time for infants aged 7 days to 3 months but a prolonged recovery in those under the age of 7 days. Good perioperative analgesia was achieved.

Summary One hundred and five children with malignant disease attended for lumbar puncture which was performed under general anaesthesia. A questionnaire was answered over the next three days to determine the incidence of post dural puncture headache. Ninety‐seven questionnaires were returned and the results show that no child aged under ten years developed a headache. Of the children aged 10–12 years, two out of seventeen developed a headache (11.8%). In children aged 13–18 years, five out of ten developed a headache (50%).

UK SummaryA case is reported of a three-year-old boy with Crouzon's syndrome who developed postoperative respiratory problems related to displacement of his tracheostomy tube, complicated by a pneumothorax.

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SIR IR-There are multiple causes of hypercapnia during anesthesia (1,2). We report an unusual cause of hypercapnia during the induction of anesthesia owing to a malfunctioning of the Pediatric Anesthesia Breathing Circuit (PDY 160-6121 PED F2 @ King System Corporation, Noblesville, IN, USA).An eight-month-old (8.4 kg) child was scheduled for proximal hypospadias repair. Induction of anesthesia was uneventful with N 2 O ⁄ O 2 (70% : 30%) and increasing sevoflurane concentrations up to 8%. After an intravenous access was secured, propofol 25 mg and fentanyl 10 mcg were administered, and the sevoflurane concentrations were decreased to 4%. The trachea of the patient was intubated without difficulty. Shortly thereafter, the CO 2 concentrations were elevated and noted to be as high as 70-80 mmHg, and oxygen saturation remained greater than 98%.Our patient was not tachypnic, and his temperature was within normal. Thus, malignant hyperthermia was not considered as a cause of the hypercapnia. The CO 2analyzing line and the CO 2 -analyzing water trap cassette were changed without effect. Check on the unidirectional valves revealed that they worked properly. The CO 2 canisters were checked and had not changed color. Further examination revealed that the inner blue tubing of the Pediatric Anesthesia Breathing Circuit (PDY 160-6121 PED F2 @ King System Corporation) had become disconnected and that the CO 2 was accumulating in the open area (See arrow, Figure 1). Upon changing the anesthesia breathing circuit, the CO 2 decreased to normal levels.Causes of hypercarbia during the induction of anesthesia are numerous. Review of the literature reveals that equipment malfunction and breathing circuit are causes of hypercarbia. We present a case of hypercarbia during the induction of anesthesia, secondary to a malfunctioning pediatric anesthesia breathing circuit. We noticed that the blue tubing inside the Pediatric Anesthesia Breathing Circuit (PDY 160-6121 PED F2 @ King system Corporation) had become dislodged. References1 Sibai AN, Kassas C, Loutfi E et al. Progressive hypoxemia, hypercarbia and hyperthermia associated with prolonged anesthesia-a case report. Middle East