This is the largest study of the incidence of VAE in children undergoing neurosurgery. Our results suggest that the sitting position can be used safely for neurosurgery in children.

Down's syndrome is a common congenital abnormality associated with characteristic morphological features, impaired intellectual development and disorders of many organ systems with a broad spectrum of severity. Many of these, including defects in cosmetic appearance, are amenable to surgical correction. The risks of anaesthesia are increased in these children. In this article the anaesthetic implications of the syndrome are reviewed and the principles of perioperative management discussed.

No abstract

A 16-month-old baby with myotonic dystrophy underwent an open Nissen fundoplication and gastrostomy insertion under general anesthesia with an epidural. Postoperative care was managed on the pediatric intensive care unit for the first 6 h. She was then discharged to the ward, where she continued to make an uncomplicated recovery. Other anesthetic management that has been used in children with myotonic dystrophy is discussed.

CORRESPONDENCE 657sidered to be at high risk of regurgitation and aspiration. However, whilst the OTC probably offers increased airway protection, its value has not been proved in this clinical situation. The LMA does not protect the trachea from regurgitated stomach contents, but has been shown, by Baraka amongst others, 4 to be life-saving on occasions where tracheal intubation and FM ventilation have both failed. The risk/benefit ratios of these two devices have not been assessed and it is premature to presume that one is superior to the other. The LMA is commonly used during general anaesthesia making it more familiar and immediately available; it can be used in children and it can also be used as an airway intubator. 5 There is also indirect evidence that LMA insertion is not compromised in the patient with a difficult airway. 6-9 In a recent trial, the LMA was used 41 times in 40 adult patients sustaining a cardiopulmonary arrest at a district general hospital. The LMA failed on only two occasions, and was successful in three cases where tracheal intubation was impossible. There were no cases of LMArelated aspiration, m