SUMMARY. Cardiac surgery is estimated to use 20% of the UK blood supply. However, there has been much interest recently in decreasing red cell and blood product use not only to ease strain on blood stocks or avoid potential transmission of infection but also to decrease post-operative transfusionrelated complications. Coagulopathies are not uncommon in cardiac surgical patients, but the time lapse for reporting conventional laboratory results has been highlighted as an obstacle to the appropriate use of blood products. Accordingly, much interest has arisen in rapid near-patient testing of coagulation and, in January 2002, a thromboelastometer (ROTEM Ò

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We have compared analgesia during labour provided by two epidural drug regimens, in a double-blind, randomized, controlled study. Group A received 10-ml bolus doses of 0.1% bupivacaine with fentanyl 2 micrograms ml-1 while group B received 0.25% plain bupivacaine 10 ml. Analgesia provided by both techniques was similar, but women in group A retained motor power in their legs and 60% chose to get out of bed. Duration of labour and time from insertion of the epidural to delivery was similar in both groups, but in group A, duration of the second stage was significantly shorter (P = 0.0003; 95% confidence interval (CI) -1.17, -0.27 h) and the incidence of forceps delivery was lower (P = 0.032). Maternal satisfaction with epidural analgesia, as assessed by VAS, was higher in group A (P = 0.04; 95% CI -0.001, 10.001).

Eisenmenger's syndrome consists of high pulmonary vascular resistance with reversed or bidirectional shunt at aortopulmonary, ventricular or atrial level. We describe the anaesthetic management of two adult females with Eisenmenger's syndrome admitted for laparoscopic cholecystectomy. One patient suffered post-operative complications, but the other case was uncomplicated. We used sevoflurane and total intravenous anaesthesia to provide general anaesthesia. Both techniques were tolerated.

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