To report the management of labour analgesia and subsequent anaesthesia for postpartum bleeding in a 19-yr-old parturient with Noonan's syndrome. Clinical features: The patient presented in active labour at 36-wk gestation. She was known to have Noonan's syndrome and had been assessed regularly throughout pregnancy. Features of the syndrome exhibited by the patient included typical facies, chest skeletal abnormalities, pulmonary valve dysplasia, mental retardation and lymphoedema. In addition, she had Factor Xl deficiency (0.46 mg.L-~) and thrombocytopenia (92 x 109.L-~), previously unreported in a parturient with this syndrome. Although epidural analgesia may have been considered the labour analgesic technique of choice, the risk of epidural haematoma caused by her bleeding diathesis made this unacceptable. This risk was balanced against the possibility of a potentially dimcult intubation due to facial abnormalities, should emergency operative delivery become necessary. Labour analgesia was provided with intravenous patient controlled opioid analgesia (fentanyl 25 /lg bolus, five minute lockout) despite her mental retardation. Dilatation and curettage required general anaesthesia after intubation with awake direct laryngoscopy using cautious sedation. Conclusion: Noonan's syndrome is characterised by multi-system involvement, requiring thorough preoperative assessment of cardiovascular, skeletal, haematological and central nervous systems. Clotting and platelet defects considerably restrict the possible analgesic and anaesthetic options for labouring patients with this syndrome. Objectif : Pr&enter une ligne de conduite appropri& pour ranalg&ie durant le travail et I'anesth&ie pour saignement post partum chez une parturiente de 19 ans porteuse du syndrome de Noonan.

~L~O~: To determine if preoperative intravenous dextrose affects the incidence and ease of treatment of spinalinduced hypotension in parturients having elective Cesarean section under spinal anesthesia. Methods: In this prospective, double-blind study, following informed consent, 119 ASA I, II parturients for elective Cesarean section were randomized to receive intravenously either dextrose 5% in normal saline (Group D) or normal saline (Group NS) at125 ml-hr I for two hours prior to delivery. Following a bolus of 15 ml'kg -I normal saline iv, spinal anesthesia was induced with hyperbaric bupivacaine 0.75%, fentanyl and morphine. Hypotension (systolic blood pressure < I00 mm Hg or >20% decrease) was treated with fluids and/or vasopressor. Data collected: demographics, blood glucose concentrations (fasting, time of spinal, delivery), blood pressure (baseline, one minute intervals from spinal to delivery), neonatal Apgar scores, umbilical blood gas analyses, glucose and lactate concentrations. Results: There was no difference between the two groups in the rate of hypotension (P=0.272). All parturients who experienced hypotension received fluids, and there was also no difference between the groups in vasopressor requirement [mean dose of ephedrine: Group D = 21.6 mg (95% CI 15.1-28.2), Group NS = 16 mg (95% CI 12.0-20.5)]. Conclusion: The routine administration of dextrose 5% at a rate of 5.22 g'hr' preoperatively does not affect the hypotension rate, or make it easier to treat.Objecl~: D&erminer si l'administration intraveineuse prEopEratoire de dextrose modifle l'incidence d'hypotension & induction rachidienne et la facilitE de son traitement chez des parturientes qui subissent une c&arienne Elective sous rachianesth&ie. M&hode : Ayant accordE leur consentement &hirE, II 9 parturientes ASA Iet II ont participE & une Etude prospective & double insu. REparties au hasarcl, elles ont re~u pendant deux heures avant la cEsarienne prEvue une perfusion intraveineuse de dextrose 5 % dans une solution salEe (Groupe D), ou d'une solution salEe (Groupe S), de 125 ml'hr -j. Apr& l'administration iv d'un bolus de 15 ml'kg -I de solution salEe, la rachianesth&ie a EtE induite avec de la bupivacaTne hyperbare & 0,75 %, du fentanyl et de la morphine. On a traitE l'hypotension (la tension art&ielle systolique < I00 mmHg ou une baisse > 20 %) avec des liquides etlou un vasopresseur. On a note : des renseignements personnels, les concentrations de glucose sanguin (& jeun, au moment

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