The comparative dose-response effects of melatonin and midazolam for premedication of adult patients: a double-blinded, placebo-controlled study. Anesth Analg 2000; 91: 473±9 3 Molina-Carballo A, Munoz-Hoyos A, Reiter RJ, et al. Utility of high doses of melatonin as adjunctive anticonvulsant therapy in a child with severe myoclonic epilepsy: two years' experience.

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Chromosome 22q11 deletion syndrome (22q11DS) is a congenital anomaly characterized by cardiovascular, oropharyngeal, immunologic, endocrine, and neurodevelopmental abnormalities. We successfully managed a 6-year-old girl with 22q11DS with general anesthesia. Potential problems in anesthetic management of patients with 22q11DS are reviewed.

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There have been recent reports of pulmonary edema (PE) complicating anesthesia-related laryngospasm (LS)1-9, and most of them were anesthetized with volatile anesthetics 2 -7,9. We have also had this experience in a patient anesthetized with nitrous oxide in oxygen, supplemented with fentanyl. We describe herein the clinical events and discuss the mechanisms of PE complicating anesthesia-related LS. Case ReportAn 18-year-old Japanese boy with bilateral retrolental fibroplasia and retinal detachment was scheduled for vitreous repair of the left eye. Preoperative physical examinations revealed no heart murmurs or adventitious respiratory sounds. Chest x-ray showed no evidence of bronchopulmonary dysplasia, and the cardiothoracic ratio was 0.42. The serum protein was 7.1 g/dl, the albumin 4.1 g/dl. Other laboratory investigations, including electrocardiogram, were all normal.He was premedicated with pentobarbital 100 mg and diazepam 10 mg, orally, and atropine 0.5 mg was administered subcutaneously 30 minutes before arrival in the operating room. The preanesthetic arterial blood pressure was 130/80 mmHg, and the heart rate 85 beats/min. Anesthesia was induced with droperidol 7.5 mg, fentanyl 0.1 mg, and thiopental 150 mg, given intravenously. After the intravenous administration of succinylcholine 60 mg, the trachea was easily intubated with a 7.5 mm cuffed Rae tube, and fentanyl 0.3 mg was given. Anesthesia was maintained with 66% nitrous oxide in oxygen. Pancuronium bromide was used for intraoperative muscle relaxation, and ventilation was controlled manually. During the two hours of surgery, the arterial blood pressure and heart rate remained stable, and he received a total of 6 mg of pancuronium and 1,000 ml of 5% dextrose in lactated Ringer's solution. At the end of the surgery, a moderate degree of spontaneous respirations was already noted, and neostigmine 2.5 mg mixed with atropine 1.0 mg was administered to antagonize the residual effect of pancuronium. He was ventilated with oxygen, and the trachea was extubated.Immediately after extubation, intense LS developed. He could not be ventilated, despite a prompt application of positive airway pressure by bag and mask. Perioral cyanosis rapidly developed, and the heart rate transiently decreased to 60 beats/min. Succinylcholine 60 mg was administered intravenously, after which he could be easily ventilated, and the trachea was re-intubated. The heart rate increased to 70 beats/min. However, massive frothy pink fluid poured out from the endotracheal tube immediately after re-intubation, Moist rales were heard over both lung fields. An arterial blood gas analysis done 20 minutes