Background: Vacuum-assisted bite-block immobilization of the head is a reliable technique for reproducible precise head positioning as used for proton radiation in adults. We report preliminary experience using deep propofol sedation without an artificial airway in children undergoing proton radiation of cranial tumors requiring vacuumassisted bite-block immobilization. Methods: Sedation was started with a bolus of i.v. midazolam followed by repeated small boluses of propofol as required to tolerate bite-block insertion and patient positioning. Sedation was maintained by continuous propofol infusion until removal of the bite block. Oxygen was administered by a nasal cannula. SpO 2 , endtidal CO 2 taken at the nose and respiratory adverse events such as coughing, bucking, airway obstruction, regurgitation or aspiration were recorded. Data are mean ± SD

A low-dose bolus of dexamethasone (0.15 mg x kg(-1)) in combination with tropisetron, compared to tropisetron alone, considerably reduced the incidence of vomiting in children following pediatric adenotonsillectomy.

Purpose: There are a number of syndromes with proven or suspected instability of the cervical spine especially in pediatric patients. It is a challenge for the anesthesiologist to intubate these patients with as little movement of the cervical spine as possible. A new device to facilitate this task is the angulated video-intubation laryngoscope (AVIL).Clinical features: The AVIL is a curved endoscopic intubation laryngoscope with angulated distal tip. The video-view from the distal blade tip improves glottic visualization during difficult direct laryngoscopy. We report three sisters with Morquio syndrome scheduled for otorhinolaryngology surgery the same day. Two of them had radiologically suspected cervical spine instability. Tracheal intubation was planned with careful direct laryngoscopy under manual in-line stabilization of the neck and head by an assistant. Direct visualization of the larynx using a Miller blade No. 2 was impaired in two of the three children in whom the cervical spine was immobilized. They were both successfully intubated under endoscopic control using the AVIL. Conclusion:The AVIL may become a helpful device to aid endotracheal intubation in patients when cervical spine immobilization impairs direct laryngoscopy.

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