During the initial phase of meningococcal disease, raised cortisol and ACTH levels indicate an appropriate stress response within the hypothalamic-pituitary-adrenal axis. However, a substantial subpopulation (11 [16.9%] of 65) has evidence of adrenal dysfunction during this period. Morning cortisol values in the initial phase of meningococcal disease could be used as a potential early index of AI.

We determined the dose-response curves and effective doses of propofol for insertion of the laryngeal mask airway (LMA) in 50 unpremedicated children and in 60 children premedicated with midazolam, aged 3-12 yr. One of several doses of propofol was administered i.v. over 15 s to groups of 10 children, and conditions for LMA insertion were assessed at 60 s. The dose-response curves were parallel (P = 0.94), but the curve for premedicated children was shifted significantly to the left of that for unpremedicated children and propofol requirements were reduced by one-third (P < 0.0001). The doses required for satisfactory LMA insertion in 50% and 90% of unpremedicated patients (ED50, ED90) (95% confidence interval) were 3.8 (3.4-4.2) mg kg-1 and 5.4 (4.7-6.8) mg kg-1, respectively; those for premedicated patients were 2.6 (2.2-2.8) mg kg-1 and 3.6 (3.2-4.3) mg kg-1, respectively.

Objectives-To review the outcome of patients with childhood malignancy requiring intensive care treatment and to assess whether there is any secular trend for improved outcome. Design-Retrospective chart reviews of 74 consecutive admissions to a paediatric intensive care unit from a regional paediatric oncology centre between 1990 and 1997. During the same period there were 6419 admissions to the oncology unit, 814 of whom were new cases. Results-The overall survival at discharge from the intensive care unit was 49 of 74. Patients with either systemic or respiratory infection requiring ventilation had the poorest survival (13 of 31) whereas postoperative patients had the best survival (15 of 15). However, patients with respiratory or systemic infection who required inotropic support with more than three agents all died compared with about one quarter of those needing no inotrope. All patients with systemic or respiratory infective illness were neutropenic and positive microbiological identification was possible in 13 of 21 and five of 18, respectively. Non-survivors had a higher mean acute physiology and chronic health evaluation system (APACHE-II) score than survivors (24.2 v 15.94, respectively) but no patient with a score of > 27 survived. Conclusion-Compared with previous series, there has been a great improvement in survival of oncology patients admitted to the intensive care unit especially those with either systemic or respiratory infection needing ventilation. Full intensive care treatment should be provided for these patients. (Arch Dis Child 1999;80:553-555)

SummaryOne thousand, eight hundred and fifty-seven patients underwent magnetic resonance imaging following the establishment of a structured sedation programme. Forty-eight of these patients came from the intensive care unit with a secure airway and were therefore excluded from any further analysis. Oral sedation was to be given to children aged 5 years and below. For children Ն 6 years old, oral sedation could be given only if their level of co-operation was judged to be inadequate by the referring physician. Oral sedation consisted of chloral hydrate 90 mg.kg ¹1 (maximum 2.0 g) orally with or without rectal paraldehyde 0.3 ml.kg ¹1 . All magnetic resonance imaging requests for children who failed oral sedation as well as those referred for general anaesthesia from the outset were reviewed by a consultant anaesthetist who then allocated patients to undergo the procedure with either general anaesthesia or intravenous sedation. Scans requiring intravenous sedation or general anaesthesia were performed in the presence of a consultant anaesthetist. Intravenous sedation consisted of either a propofol 0.5 mg.kg ¹1 bolus followed by an infusion (maximum 3 mg.kg ¹1 .h ¹1 ) or midazolam 0.2-0.5 mg.kg ¹1 boluses. General anaesthesia was given using spontaneous ventilation with a mixture of 66% nitrous oxide in oxygen and isoflurane following either inhalation (sevoflurane) or intravenous (propofol) induction. One thousand and thirty-nine (57.4%) of the scans were done without sedation whereas 93 scans were performed during the consultant anaesthetist supervised sessions. Oral sedation failed in 50 out of 727 patients (6.9%). Eighty-seven per cent of children aged 5 years and below needed sedation compared with 4.5% of those aged over 10 years. Two patients who had only received chloral hydrate developed significant respiratory depression. This structured sedation programme has provided a safe, effective and efficient use of limited resources.

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