The occurrence of a thyroid gland superficially placed on the pharyngeal portion of the tongue is rare, but poses problems to the patient and anaesthetist. This report describes a patient with a lingual thyroid and a history of problems associated with it that resulted in admission to the ICU and warnings about future intubation of the larynx. The patient underwent awake tracheal intubation using a standard fibreoptic assisted technique, and was advised that she purchase an appropriate Medic‐Alert bracelet.

The reported frequency of detection of air embolism during neurosurgical operations carried out in the sitting position has varied widely, from 1.6%' to as high as 93%,2 but the mortality associated with this complication has ranged from 73X3 to The method of detection is relevant to the apparent incidence of embolism since the more sensitive methods have been shown to increase the frequency of diagnosis.Numerous clinical and instrumental methods of diagnosing the presence of air in these circumstances have been described. These include the observations of hypotension, cardiovascular collapse4 and rise in venous p r e~s u r e ,~ dysrhythmias6 and

A case report is presented in which an asthmatic patient appears to have developed bronchospasm after being given pancuronium. A review of the literature indicates that this agent is the least likely of muscle relaxants in clinical use to provoke such a response, and that no such case has hitherto been reported. It is suggested that caution should be exercised even when pancuronium is used in asthmatic patients, and that those susceptible to bronchospasm in association with this agent might be identified by preanaesthetic skin sensitivity testing.

No abstract