Although vasospasm usually occurs in the presence of normal coronary arteries, its clinical course is indistinguishable from coronary ischaemia, and actual myocardial damage frequently occurs, as demonstrated by ECG changes and troponin rises seen in such cases. Spasm can be promptly and effectively treated if recognized early, and treatment with nitrate therapy is often sufficient to abolish spasm. As patients are awake during deep brain stimulation (DBS) surgery and may be under considerable distress should vasospasm occur, based on the present case report, it is our opinion that in all cases of DBS surgery, full patient monitoring should be mandatory and an anaesthetist should be present throughout the case. Furthermore, if there is a previous history of cardiac disease or vasospasm, the use of 5-lead ECG monitoring and premedication with beta-blockers and nitrates are indicated.

We describe the use of epidural analgesia for vaginal delivery of a parturient with Klippel-Trenaunay syndrome in whom the use of repeated magnetic resonance imaging during her obstetric care allowed us to see deep haemangiomata. This also allowed the safe sitting of an epidural catheter at L1-2 to provide analgesia for labour and delivery. Klippel-Trenaunay syndrome and the anaesthetic implications of the congenital vascular abnormalities and potential coagulopathy are discussed.

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