SummaryThe volumes and pH of gastric aspirates obtained from 110 children (aged 1-14 years) who underwent surgery for trauma were related to the duration of pre-operative starvation and to the interval between food and injury. Aspirates were larger in children fasted for 4-6 hours than in those fasted for up to I0 hours, and were larger in children injured within 2 hours of eating than in those in whom this interval was longer ( p < 0.05). However, 19 of 39 children (49%) starved for over 8 hours had an aspirate of more than 0.4 mllkg. as did$ve of 16 children (31%) injured 3 or more hours after eating. Thus, a 'safe' interval between oral intake and induction cannot be predicted. We conclude that securing the airway by prompt tracheal intubation is the safest way to manage any child who presents for emergency anaesthesia after trauma. Key wordsAnaesthesia; paediatric. Gastrointestinal tract; gastric volume, pH.Children who are injured shortly after eating and who then present for emergency surgery may be at particular risk of pulmonary aspiration of gastric contents. It is widely assumed both that gastric emptying is slowed in these patients, and that the interval between last oral intake and injury has greater relevance than that between last intake and induction of anaesthesia. These assumptions, however, have not been tested formally.This study aimed to gain information about gastric volumes after trauma in children, and to define the population of patients at greatest risk of pulmonary aspiration of gastric contents. MethodsOne hundred and ten children aged between 1 and 14 years were admitted to the study which received prior approval from the Hospital Ethics Committee. These were consecutive patients who sustained injury to the limbs or face. Children with burns or scalds, and those in whom a facial or scalp injury was associated with intracerebral trauma, were not included. Patients who required intra-oral or body cavity surgery were also excluded, as were children taking medication known to modify gastric emptying and children with any history of gastrointestinal disease.The times of injury and of last oral intake were obtained from the patient or parent at the visit beforehand. The assessment of the accuracy of these times was necessarily subjective. However, many children were injured at play after a meal eaten at a regular time, and there was often more than one parent or teacher to corroborate the information. Children were excluded from the study if there was any uncertainty. Injuries were categorised as minor (e.g. small laceration) moderate (e.g. fractured radius and ulna) or major (e.g. fractured femur).Patients were given analgesia as appropriate (pethidine 1 mg/kg or morphine 250 pg/kg to a maximum of 10 mg) but received no other premedication. Children were asked if they were hungry before induction of anaesthesia. A rapid sequence induction (pre-oxygenation in children who could cooperate; thiopentone 5 mg/kg; cricoid pressure; suxamethonium 1 mg/kg and tracheal intubation) was used in every...

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Correspondence 1 7 1 dreams. One of these patients did admit on close questioning that he had drcamt about his anacsthetist but he refused to elaborate on the nature of his experience.We wonder whether it was the good looks of our colleagues at the Middlesex or maybe the surgical stimulation involved which promoted the reported uninhibited female behaviour and whether the incidence of this phenomenon could be reduced by an increased propofol dosage.

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We have examined the effect of preoperative administration of nebulized lignocaine or saline on the intraocular pressure (IOP) response to tracheal intubation in 20 adults. In the saline group, tracheal intubation was associated with a significant increase in IOP above control and preintubation values (P less than 0.01); in the lignocaine group there was no change in IOP following intubation. After intubation, IOP was significantly less in the lignocaine group than in the saline group (P less than 0.05).