In order to evaluate the validity of formulas for estimating tracheal tube size, we compared actual tube size with the calculated size from a formula based on age in 623 children over 1 year (tube size (mmID)=age(y)/4+4) and a formula based on height in 877 infants and children (tube size (mmID)=height(cm)/30+1 for infants under 1 year, tube size (mmID)=height/20 for children 1 year and older). In 2 cases in which the actual tube size deviated by 1 mm or more from the estimated tube size, the possible causes were investigated. Estimates from the height-based formula tended to be smaller than the actual size, while those from the age-based formula tended to be larger. Tubes at least 1 mm smaller than estimated by the height-based formula were used in 2 cases with micrognathia and repaired cleft palate. Similar deviations from the age-based formula were noted in 6 children with short stature and low weight. In one child with repaired esophageal atresia, short stature and low weight, the actual size was 1 mm smaller than both calculations. In 2 children in whom the actual tube sizes were at least 1 mm larger than the tube sizes estimated from the height-based formula, no obvious causes were found.

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The effects of flurbiprofen axetil in post-operative pain relief in 59 children after ophthalmic or otolaryngologic operations were compared to those of diclofenac sodium.
Flurbiprofen axetil (0.1mg/kg) was applied intravenously, and diclofenac sodium (0.1mg/kg) was administered via the rectum. Facial pain scales with the two drugs did not differ significantly for five hours after operations. However, doses of additional analgesic in the flurbiprofen axetil group were statistically less than those in the diclofenac sodium group. No severe complications were observed in either group.
We conclude that intravenous flurbiprofen axetil is effective for pain relief after pediatric operations.

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Laser ablation procedures under general anesthesia were performed in 20 patients. All patients complained of dyspnea at exercise or at rest. Mean preoperative FEV 1.0%, mean PaO₂ and mean PaCO₂ in room air were 31%, 71mmHg and 42mmHg, respectively. Induction of anesthesia was conducted with ketamine, midazolam and vecronium. Double lumen endtracheal tube was inserted. Anesthesia was maintained with isoflurane in 100% oxygen. We used pressure-controlled ventilation and limited peak airway presure to below 25cmH₂O. Cardio-pulmonary data were recorded 20min after intubation (TLV-1), 20min after one lung ventilation (OLV) and 20min after re-expansion of the operative lung (TLV-2). PaO₂ and tidal volume decreased from TLV-1 values to OLV values. Peak airway pressure and shunt increased from TLV-1 values to OLV values.

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Facial pain has numerous causes. A 22-year-old female complaining of severe facial pain was suspected of having styloid process syndrome, because X-rays demonstrated both an elongation and a fracture of the left styloid process. Administration by local infiltration of 2mg of dexamethasone and 1ml of 2% mepivacaine reduced the stubborn pain, which had proven resistant to analgesics. Surgical excision of the styloid process is generally considered the most effective strategy for treating this syndrome. However, because of the surgical risk and the difficulty of establishing a clear diagnosis, local infiltration of glucocorticoid in conjunction with local anesthetics seems to be an effective alternative for the treatment of nociceptive pain, as demonstrated in this case.

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We experienced the failure of a needle valve of an oxygen f lowmeter. While there was nothing wrong with the anesthesia machine at the preanesthetic check, we found that the oxygen flowmeter did not work at all just before anesthesia. The problem was due to the needle valve being fitted so tightly into the nozzle that the spring could not separate them. Stricter quality checks should be conducted by the manufacturer. Equipment also should be checked more carefully.

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