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Atropine and glycopyrrolate were compared when given in a mixture with neostigmine for the reversal of non-depolarising neuromuscular block in children. Glycopyrrolate was an effective antimuscarinic agent and could be safely used as an alternative to atropine, although the advantages in this age group were not as marked as have been observed in adults.

Changes in oxygen saturation (SaO2) were studied during induction of anaesthesia in 48 healthy children receiving halothane or isoflurane for outpatient dental extractions. Substantial reductions in SaO2 occurred in more than 50% of the children given isoflurane and were associated with the irritant effects of this agent on the airway. SaO2 was largely unaltered during the use of halothane. These findings indicate that the airway complications caused by isoflurane may be associated with decreases in SaO2.

Three patients with sensitivity to an intravenous anaesthetic-thiopentone, propanidid, and Althesin (alphadolone and alphaxalone)-are described. In the cases of thiopentone and Althesin the reaction was characterized by cardiovascular collapse, while bronchospasm also occurred with thiopentone. The reaction to propanidid was a direct skin sensitivity. All patients had a personal or family history of asthma and all had been previously exposed to the offending drug. A leucocyte challenge test showed an allergic response to thiopentone and Althesin in two patients but gave a negative result in the patient with the skin reaction. Allergic reactions can occur to all types of intravenous anaesthetics in a few patients.

Direct measurements of arterial blood pressure and intracranial pressure were recorded in 39 patients aged 3.6 months to 5 years 11 months with Reye's syndrome judged to be stage 2 or beyond. Of 33 patients who survived, 27 made a full recovery and six were severely handicapped. Measurement of cerebral perfusion pressure, which is greatly reduced in the more severe forms of Reye's syndrome, was a better guide to prognosis and management than intracranial pressure alone. The findings emphasise that maintenance of cerebral perfusion pressure is essential if mortality and morbidity are to be reduced. Intracranial monitoring is mandatory in all but the mildest cases of Reye's syndrome.

Reye's syndrome, an uncommon childhood encephalopathy of uncertain aetiology, is an important cause of mortality and permanent handicap. Since its recognition treatment has changed, current management focusing upon prevention or control of raised intracranial pressure. Prognosis is radically improved by early recognition and prompt transfer to a specialist centre.

A survey of neonatal deaths occurring over two years in Northern Ireland disclosed that many hospitals where babies could be born probably could not be staffed and equipped to deal effectively with major perinatal problems. The incidence of congenital malformations, especially neural tube defects, was high. A reduction in neonatal deaths from this cause might be expected if facilities for antenatal diagnosis and termination of pregnancy were made available, although this raises grave ethical problems. Many infants died of prematurity and the idiopathic respiratory distress syndrome. A considerable reduction in neonatal deaths might be expected with improved care at the place of delivery backed by a regional centre with facilities for transporting and treating severely ill infants needing intensive care.