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Pneumopericardium is an unusual complication of mediastinal emphysema in infants. It is rarely recognized clinically, yet the symptoms and signs are characteristic, and the prompt relief of the gas tamponade by pericordotomy is lifesaving. Six infants with this condition have been observed in the past 2 years, and all were receiving positive pressure mechanical respiration. Two were recognized clinically, and prompt surgical measures were instituted with success.It is the purpose of this paper to call attention to this condition, discuss the etiology, the signs and symptoms, surgical relief, and prevention. Report of CasesCase 1.\p=m-\Awhite boy, 3\m=1/2\months old was admitted because of progressive enlargement of the head, and studies revealed noncommunicating hydrocephalus. A ventriculoatrial operation was planned, and as the ankle phlebotomy was being performed prior to surgery, under endotracheal anesthesia, the heart sounds became progressively distant. The pulse was quenched, and cardiac arrest occurred. No subcutaneous emphysema was noted. A left thoracotomy was quickly done, and a glistening membrane bulged into the chest wound. There was no pneumothorax, but mediastinal emphysema was present. The distended membrane was identified as markedly distended pericardium filled with gas, which escaped under pressure when this sac was incised. The heart appeared small in its large cavity, and no beat was noted. Manual stimulation reestablished sinus rhythm in a few seconds. The duration of the cardiac arrest was 3 minutes. The pericardium was closed, except for a 2.0 cm. window, and the left chest was closed under water seal. Recovery was without incident, and 12 days later, the ventriculoatrial shunt was carried out without further complication.The child was last seen at one year of age, with the shunt functioning well, and the child starting to stand by himself.

N 1950 Wyliel reported that 70 of 100 I unselected adult patients intubated under ether or cyclopropane anesthesia complained postoperatively of either mild or severe sore throat. Baron and Kohlmoos2 in 1951 found that 80 consecutive adults noted a mild degree of discomfort during the first 24 hours following intubation; none, however, developed important sequelae. In 1958 Wolfson2 questioned 521 adult patients directly and observed that 18.4 per cent complained of postintubation soreness; 4.5 per cent of these patients also had objective findings of hoarseness or loss of voice. Conway and associates4 in 1960 found a 38.2 per cent incidence of postintubation sore throat in a series of 642 adult patients interrogated directly. In 1964 Hartsell and Stephen? revealed that 5.7 per cent of 400 adult patients questioned indirectly complained of postintubation sore throat.Deming and OechG in 1961 described the use of dexamethosone and diphenhydramine in the treatment of severe postintubation subglottic edema in children. Jafle7 in 1964 reported the effectiveness of dexamethasone in reducing and eliminating postoperative laryngeal edema in children 5 years old and under who were intubated nasotracheally for dental procedures.The purpose of the current project was to confirm or refute our clinical impression that a single intravenous dose of corticosteroid, given at the time of intubation, reduced the morbidity of endotracheal intubation for anesthesia. METHODBy a double-blind study, the influence of the synthetic anti-inflammatory corticosteroid, bet ame t hasone, on postintubation

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