Key wordsPain; postoperative. Surgery; thoracic.The use of parenterally administered opiates as required in the conventional manner for postoperative pain relief has known disadvantages of which respiratory depression, nausea and vomiting, and inadequate pain relief are the most well recognised. In thoracic surgery in particular, any one of these disadvantages is potentially a major hazard. In an assessment of alternative methods of pain relief following thoracic operations over 60 patients in the authors' unit have had thoracic epidurals. The first two years' experience of the technique is pnsented. Method Paiieni seleciionNo specific guidelines were laid down for selection of patients for the study, but those with the accepted contraindications to the performance of an epidural block were excluded. Also excluded were patients with a history of cerebrovascular or cardiac disease whose condition could be compromised by the onset of hypotension which might be associated with

We describe the management of a patient with Eisenmenger's syndrome presenting for laparoscopic cholecystectomy. Of prime concern was maintenance of systemic vascular resistance and this was achieved using infusion of noradrenaline started before induction of anaesthesia and continued after operation. Avoidance of other factors that could potentially increase right to left shunt flow contributed to the successful outcome.

Two children who developed chylothorax after surgery for congenital heart disease are presented. The conservative management of chylothorax is reviewed and the use of immunoglobulins in the treatment of sepsis is discussed. One patient survived.

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The use of thoracic epidurals for postoperative pain relkf in 58 patients following thoracic surgery i s reviewed. Epkhral catheters were inserted at the end of the operative procedure and it was planned that analgesia was 10 be maintained with a continuous infusion ofbupivacaine. In those patients with evidence of successful neurological blockade there was a high incidence of adverse effects. Hypotension occurred in nearly 8V/, of patients and inaikquaie analgesia necessitating intramuscular opiates in 30%. The results suggest that the method adopted is unsuitable for some paiients who have undergone major pulmonary surgery, although it has proved a useful adjuvant for pain relief in patients who have had other intrathoracic operations.