Venous embolism of carbon dioxide occurred during elective diagnostic laparoscopy in a healthy adult female. The diagnosis of gas embolism was made on the basis of the sudden abrupt onset of systolic and diastolic murmurs. The continuously recorded end-tidal carbon dioxide concentration (FETCO2) increased abruptly from 3.8 to 4.2 per cent and then slowly decreased to 4.0 per cent over the subsequent 30 seconds. CO2 insufflation was terminated immediately following the establishment of the diagnosis. The patient recovered uneventfully. A transient but rapid rise in FETCO2 is suggested as a useful early sign of venous CO2 embolism during laparoscopy.

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IntroductionDetermination of normal values for many aspects of lung function in preschool children is often difficult since they do not readily comprehend instructions for pulmonary function testing and can be uncooperative. One basic aspect of lung function that can be measured in anesthetized (1) and in awake cooperative preschool children (2) is FRC. Normal values have been derived for sitting and standing subjects (2-4). However, these studies may not be applicable to supine children, as the FRC is known to decrease when assuming the supine position (2, 3, 5). In order to evaluate FRC measurements made on ill children, who are usually nursed in the supine position, reference values for healthy children lying supine are necessary. Reference values have been published for healthy children younger than 3 yr of age (2,6) and older than 6 yr (7) while recumbent. However, FRC values for healthy, supine children between the ages of 3 to 6 yr are not available, and extrapolation from data available for younger or older children to this age group may not be valid in view of the nonlinear relationship between lung volumes and height, age, or weight (3). We therefore measured FRC in healthy supine children, including those 3 to 6 yr of age, with and without anesthesia, in order to establish reference values and to examine normal lung growth in preschool children.

Sixty-three patients with Down's syndrome underwent facial reconstructive surgery under general anaesthesia in order to improve their acceptability and potential for functioning effectively in society. Preoperatively, one-third of the patients had respiratory illnesses, 11 (17.5%) had cardiac anomalies, and 5 (7.9%) had endocrinological abnormalities. Anaesthesia was based on spontaneous ventilation of halothane and N2O in oxygen via an endotracheal tube with appropriate monitoring. Only one patient had an intraoperative complication, an episode of ventricular dysrhythmia, but postoperatively 9 patients required nasopharyngeal airways or endotracheal intubation in order to maintain a patent upper airway. The anaesthetic considerations for facial reconstructive surgery in Down's syndrome are discussed.