A prospective, randomized, double-blinded, placebo-controlled clinical trial was conducted in 41 patients evaluating the effect of a single preoperative dose of intravenous dexamethasone on postoperative vomiting and pain in children undergoing elective tonsillectomy. Dexamethasone was found to significantly reduce the incidence of vomiting in the first 24 hours postoperatively (P=0.02), the time to first intake of solids (P=0.001), the need to administer a rescue antiemetic (P=0.005) and intravenous fluid therapy requirements (P=0.006) in the postoperative period. No significant difference was found between the dexamethasone and placebo groups in the time to first intake of fluids, pain scores or analgesic requirement postoperatively. These results indicate that dexamethasone substantially reduces morbidity after tonsillectomy in children.

The ASA Grading System shows poor interrater reliability in pediatric practice, as it does in adults. This should be borne in mind when using the ASA System for clinical or scientific work in pediatrics. A physical status grading system developed specifically for use in pediatrics may reduce inconsistency.

Patients suffering from the mucopolysaccharidoses, most commonly Hurler's syndrome, present special problems in anaesthesia. A retrospective review of the anaesthetic management of such patients over fifteen years revealed a high incidence of airway problems. Two case histories illustrating these difficulties are presented.

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