The effect of the combination of opiates and hypnotics on bispectral index (BIS) is unclear. This double-blind placebo-controlled trial investigated the effect on BIS and sedation of different infusion doses of remifentanil combined with a steady infusion of propofol. Forty patients initially received a target-controlled infusion of propofol 2 micrograms ml-1 for 15 min. They were then randomized to receive either placebo, 0.01, 0.05 or 0.1 microgram kg-1 min-1 remifentanil for a further 15 min. We found a significant correlation between the dose of remifentanil and the change of BIS after 15 min of infusion. The correlation between all the sedation scores and their corresponding BIS was also significant. We concluded that remifentanil, in combination with propofol, reduces BIS when used for sedation.

The diagnosis of phaeochromocytoma during pregnancy is rare. We present the management of vaginal delivery in a woman diagnosed with the condition during labour. A Medline search and follow-up of references failed to find any similar report in the last 30 years.

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Dr. Goresky stated that "Clearly, midazolam does not offer an advantage over low concentrations of bupivacaine..." Although this statement was not substantiated with any scientific evidence, absence of major side effects (cardiovascular and central nervous system toxicity) with bupivacaine in our study do not mean that these complications do not exist. Definitely, inadvertent intrathecal or intravascular administration of 50 pg. kg -t midazolam will not result in any of these side effects inherent in bupivacaine.In contrast to Dr. Goresky's opinion, we believe that the evidence provided in the literature and in our study indicate that epidur,'tl administration of midazolam provides a safe and an effective method for postoperative analgesia in children.

A Penlon Sigma isoflurane vaporizer was found to contain some diethyl ether. This had escaped from a ruptured temperature compensation device within the vaporizer. The Datex AS/3 vapour analyser detected the foreign agent and displayed a warning. Different types of vaporizer compensation devices are highlighted and the use of vapour analysers is discussed. We conclude that these analysers are invaluable for indicating that the patient is receiving the correct concentration of an inhalation agent but are of little use in the detection of all but a few possible contaminants.