This case report describes the peri-operative management of a 48-year-old woman with three cerebral aneurysms and phaeochromocytoma. The pharmacological and anaesthetic management of such patients is complex, and needs to be managed carefully by titrating anaesthetic agents and vasoactive drugs. The primary concern is the maintenance of cerebral perfusion pressure and autoregulation throughout the procedure, although these states cannot be monitored directly. The patient survived the operation neurologically intact, and it is presumed that the course of management which was chosen helped to achieve this result.

The onset of malignant hyperthermia in a patient during a prolonged anaesthetic for tumour resection is described. The onset was delayed with a gradual rise in heart rate and PetCO2 before becoming fulminant; muscle rigidity was not a feature. Other aspects of the patient’s condition confused the presentation, delayed the diagnosis and may have been involved in precipitating the event. However, it responded rapidly to treatment and surgery was continued. A possible recrudescence occurred 18 h later. Malignant hyperthermia should be considered early in cases of unexplained tachycardia or rising PetCO2.

Laparoscopic Nissen fundoplication is becoming a popular technique in the surgical management of reflux disease. The advantages of laparoscopic surgery include shorter hospital stays, greater patient acceptance and decreased overall morbidity [1]. Laparoscopic surgery eliminates the necessity for an upper abdominal incision and the consequent post-operative impairment of pulmonary mechanics [2]. Laparoscopic Nissen fundoplication has been associated with a low incidence of severe peri-operative complications although of a different nature to those following the open procedure [3]. We are reporting a rare case of acute cardiovascular collapse secondary to cardiac tamponade during laparoscopic Nissen fundoplication.

Morphine is recommended as the strong opioid of choice by the World Health Organization (WHO) for cancer pain management. It is associated with delay in gastro-intestinal transit; as a result, patients may experience marked constipation. We describe a case of intestinal pseudo-obstruction associated with the use of oral morphine in a terminally ill cancer patient.

We present a case of a 25-year-old woman undergoing resection of a large phaeochromocytoma at 16-weeks gestation.

A patient undergoing emergency laparotomy for an acute abdomen developed fatal air embolism as a result of surgical manipulation of a cavitating metastatic lesion of the liver. The diagnosis was made at postmortem examination. This cause of air embolism has apparently not been reported before. The causes and management of air embolism are briefly reviewed. It is concluded that in exceptional circumstances when intubated patients are sent to a recovery area, the continuation of CO2 monitoring into the post-operative period should be considered.