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.

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.

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.