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SummaryThe effect of oral premedication was investigated in a double-blind, randomised trial in 85 children undergoing tonsillectomy and/or adenoidectomy. Orally administered midazolam 0.5 mg.kg ¹1 given 30 min pre-operatively was compared with trimeprazine 2 mg.kg ¹1 given 90 min pre-operatively and a placebo preparation. Compliance, sedation and ease of induction were assessed as were the duration and quality of recovery. Following premedication with midazolam none of the patients was anxious, crying or distressed on leaving the ward, compared with 2/28 in the trimeprazine group and 5/28 in the placebo group (p ¼ 0:0007). More patients were calm and quiet on arrival in the anaesthetic room following midazolam than following trimeprazine, with both premedicant agents comparing favourably with placebo. There was no significant difference between the three groups in the time to recovery or the sedation score on discharge to the ward. Midazolam is a safe and effective oral premedicant for children.

To report the management of labour analgesia and subsequent anaesthesia for postpartum bleeding in a 19-yr-old parturient with Noonan's syndrome. Clinical features: The patient presented in active labour at 36-wk gestation. She was known to have Noonan's syndrome and had been assessed regularly throughout pregnancy. Features of the syndrome exhibited by the patient included typical facies, chest skeletal abnormalities, pulmonary valve dysplasia, mental retardation and lymphoedema. In addition, she had Factor Xl deficiency (0.46 mg.L-~) and thrombocytopenia (92 x 109.L-~), previously unreported in a parturient with this syndrome. Although epidural analgesia may have been considered the labour analgesic technique of choice, the risk of epidural haematoma caused by her bleeding diathesis made this unacceptable. This risk was balanced against the possibility of a potentially dimcult intubation due to facial abnormalities, should emergency operative delivery become necessary. Labour analgesia was provided with intravenous patient controlled opioid analgesia (fentanyl 25 /lg bolus, five minute lockout) despite her mental retardation. Dilatation and curettage required general anaesthesia after intubation with awake direct laryngoscopy using cautious sedation. Conclusion: Noonan's syndrome is characterised by multi-system involvement, requiring thorough preoperative assessment of cardiovascular, skeletal, haematological and central nervous systems. Clotting and platelet defects considerably restrict the possible analgesic and anaesthetic options for labouring patients with this syndrome. Objectif : Pr&enter une ligne de conduite appropri& pour ranalg&ie durant le travail et I'anesth&ie pour saignement post partum chez une parturiente de 19 ans porteuse du syndrome de Noonan.

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