Dengue fever is a debilitating mosquito-borne disease caused by dengue virus. We reported a case of femoral compression neuropathy due to iliopsoas hematoma complicating dengue hemorrhagic fever. Iliopsoas muscle hematoma can cause femoral neuropathy with resultant pain and paralysis. Such manifestations are not well documented in the literature. The pathogenesis of hematoma and compressive neuropathy with its appropriate management is discussed.

We describe an infant with frontometaphyseal dysplasia, who presented to us twice for anaesthesia for orthopaedic surgery. These patients have facial asymmetry, mandibular hypoplasia, bradycardia, restrictive lung disease, primary pulmonary hypertension, skeletal abnormalities and difficult endotracheal intubation. The patient also showed laryngeal stridor because of laryngomalacia, vocal cord paralysis and subglottic stenosis. Light premedication along with atropine, ECG and blood pressure monitoring, gradual inhalational induction and intubation of the spontaneously breathing patient, careful positioning and postoperative CPAP are recommended.

SummaryA case of one infant of twins who developed suxamethonium apnoea is described. Investigation o j the ,famiIv revealed him to be homoqgous for atypical cholinesterase while the other twin ivas normal. Ti.r.rue H L A and blood typing indicuied the trvins to he identical. Key wordsComplication: prolonged apnoea Enzvmes: plasma cholinesterase.Prolonged apnoea after suxamethonium is due mostly to a genetic variant of plasma cholinesterase but may also be due to low levels of the enzyme or may occur in liver disease,' organophosphorous poisoning,* m a l n~t r i t i o n .~ hyperpyre~ia.~ burns and myxoedema.6 We report a case of suxamethonium apnoea due to atypical cholinesterase in one of 4-month-old twins. Case historyTwo 4-month-old male twins, with right-sided inguinal hernias, were to bc operated on in the same operating list. one after another.They were delivered by emergency Caesarean section for premature labour (30 wccks) with bicornuate uterus. The mother received suxamethonium for general anaesthesia without any problems. Twin A weighed 1.5 kg at birth and received nasal continuous positive airway pressure (CPAP) for 24 hours for respiratory distress. Twin R weighed 1.8 kg at birth and was cyanotic. Following intermittent positive pressure ventilation (IPPV) he was found to have a pneumothorax on the right side. This was treated with a chest drain and he was treated with IPPV for 46 hours. Recovery and growth were uneventful and chest X ray and echocardiogram were normal.Twin A weighcd 5.6 kg bcforc planncd surgery. He received no premedication. Anaesthesia was induced with oxygen, nitrous oxide and halothane with a Mapleson D (Hafnia) system. A 25-G butterfly-type needle was inserted into the dorsum of the left hand and intravenous atropine 0.1 mg was followed by suxamethonium 5 mg. The patient's trachea was intubated with a 3.0-mm Portex orotracheal tube. Anaesthesia was maintained with oxygen, nitrous oxide, halothane and 2 mg pethidine intravenously. Intra-operatively the child was apnoeic and IPPV was continued manually; the electrocardiogram and rectal temperature were monitored continuously. The procedure lasted for one and a quarter hours and at completion the patient was still apnoeic. Suxamethonium apnoea in a 4-month-old twin 869 rcvcrsc central depression, if any, due to pethidine. However, this did not have any effect. The child was tested for residual neuromuscular block. There was no twitch or tetanus present even at the maximal voltage and, therefore, a provisional diagnosis of suxamethonium apnoea was made. At this stage the child was flaccid and apnoeic. He was transferred to the postoperative ward and IPPV was continued with a Servo 900C ventilator. The child made a complete recovery after one hour (two and a quarter hours after the administration of suxamethonium). His trachea was extubated and he was transferred to the ward.Twin B was the next to be operated upon for thc same condition. He received 12 mg trimeprazine tartrate (Vallergan) orally 2 hours earlier.He was given atropin...