The rotational technique was associated with a higher success rate for insertion and a lower incidence of complications in children. Using the rotational technique with a partially inflated cuff could be the first-choice approach in paediatric patients.

Objectives Diazepam is widely used to relieve preoperative anxiety in patients. The objective of this study was to investigate the effects of polymorphism in CYP2C19 and the effects of CYP3A4 messenger ribonucleic acid (mRNA) content in blood on recovery from general anesthesia and on diazepam pharmacokinetics. Methods Sixty‐three Japanese patients were classified into the following 3 genotype (phenotype) groups on the basis of polymerase chain reaction–restriction fragment length polymorphism analysis of CYP2C19 polymorphism: no variants, *1/*1 (extensive metabolizer [EM]); 1 variant, *1/*2 or *1/*3 (intermediate metabolizer [IM]); and 2 variants, *2/*2, *2/*3, or *3/*3 (poor metabolizer [PM]). We assessed the effects of these polymorphisms and of CYP3A4 mRNA content in the lymphocytes on the patients' recovery from general anesthesia. Results CYP2C19 genotyping analysis in the 63 subjects showed that 32%, 46%, and 22% of subjects were classified into the EM, IM, and PM groups, respectively. The PM subjects showed a larger area under the curve representing the concentration of diazepam over a 24‐hour period (AUC0–24) (2088 ± 378 ng/mL · h−1, P = .0259), lower clearance of diazepam (0.049 ± 0.009 L · h−1 · kg−1, P = .0287), and longer emergence time (median, 18 minutes; 25th‐75th percentile range, 13–21 minutes; P<.001) in comparison with subjects in the EM group (AUC0–24, 1412 ± 312 ng/mL; clearance, 0.074 ± 0.018 L · h−1 · kg−1; and emergence time, 10 minutes, 8–12 minutes [median and 25th‐75th percentile range]). The IM group also showed a longer emergence time (median, 13 minutes; 25th‐75th percentile range, 9–20 minutes; P<.001) and a larger variation in this parameter in comparison with the EM group. The distributions of the CYP2C19 genotype were significantly different between the 2 groups (rapid emergence < 20 minutes, slow emergence > 20 minutes) (P = .0148). The mean value of the CYP3A4 mRNA level in the slow‐emergence group (mean ± SD, 4.80 ± 3.99 ×10−10) was significantly lower than that of the rapid‐emergence group (mean ± SD, 12.50 ± 11.90 ×10−10) (P = .0315). However, there was no significant correlation between emergence time and CYP3A4 mRNA levels (r = 0.239, P = .0601). Conclusion We found that the CYP2C19 genotype affects diazepam pharmacokinetics and emergence from general anesthesia and that the slow‐emergence group possesses lower levels of CYP3A4 mRNA than are found in the rapid‐emergence group. Clinical Pharmacology & Therapeutics (2005) 78, 647–655; doi:

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We obtained venograms of the right internal jugular vein in children with congenital heart disease. Generally, the diameter increased with the patient's body size, but disproportionately small vessels were seen in 8% of the patients. Preoperative internal jugular venography may facilitate identifying those patients.

Intervertebral epidural anesthesia using the "drip and tube" method is safe and practical in infants and children.