Unexpected complications of intranasal midazolam premedication

syringe of air was used for inflation. The catheter has an indwelling wire, which is radio-opaque allowing easy visualization under II. The wire also functions as a malleable stylet so that a small curve can be placed in the catheter to aid positioning. The catheters short length makes it easy to insert and secure. In both cases no readjustment of position of the catheter was required after the patient was turned laterally. Congenital cystic adenomatoid malformation of the lung is more frequently diagnosed at an earlier age because of the increase in routine antenatal ultrasound scanning. Certain types of the condition are potentially curable with lung resection. If the disease is treated conservatively this can lead to chronic lung infections. The lesions have also been found to undergo malignant change and this has occurred in patients as young as 15 months of age (3). Thoracotomy and lung resection are occurring in a younger age group to avoid these complications and it is felt that the ideal time for surgery for the condition is between 3 and 12 months of age (4–6). SLV in the infant population is therefore being required more frequently. In infants because of the size of available equipment the choices for achieving SLV have really been limited to either endobronchial intubation or bronchial blockade (7). A recent study by Pawar and Marraro described the use of the Marraro double lumen tube in infants and children. This technique appears very promising but this device is currently not commercially available (8). A large concern with bronchial blockade is the high pressure, low volume characteristics of most blockers and thus the potential to cause tissue damage (9). The Cook wire-guided endobronchial blockers have a cuff with low pressure characteristics however the smallest size available limits its use to children over the age of 1 year (7,10). We found the ability to gradually inflate the Syntel biliary catheter to just seal the bronchus a positive characteristic. The potential problem of catheter dislodgment into the trachea causing complete occlusion of the airway was fortunately not encountered in these two cases. However this complication must be born in mind when any form of bronchial blockade is used. The radio-opaque nature of the catheter allowed easy visualization within the respiratory tree under II guidance and positioning of the catheter was therefore relatively simple. Its shorter length also made insertion easier. Since Vale first illustrated the use of bronchial blockade in children in 1969, many devices and techniques for insertion have been described (11). We believe the Syntel biliary catheter to be a useful device for bronchial blockade in infants and have found the technique for insertion under II to be simple and effective when other methods of insertion, such as FOB, are precluded because of patient size and lack of equipment. The authors wish to thank Drs Judy Kermode and Helen Nicol for their help in caring for these patients. Alice K. Summons B M E D Patrick T. Farrell M B B S F R C A F A N Z C A Department of Anaesthesia, John Hunter Hospital, Newcastle, NSW, Australia (email: a.summons@bigpond.com)