The anaesthetic management of patients for microvascular free transfer surgery requires a sound knowledge of circulatory physiology. It is important to maintain adequate arterial pressure and cardiac output. Hypervolaemic haemodilution to a haematocrit of about 35% increases the cardiac output and improves flow in the microcirculation. Systemic heat loss must be minimized and the transplant itself kept warm. Hypocapnia is to be avoided. Analgesia must be adequate. The degree of any induced vasodilatation must be balanced against the effect on the systemic arterial pressure. Measures instituted in theatre to produce optimum circulatory conditions must be maintained in the postoperative period.

Restriction of elbow motion after trauma is a well‐recognized problem. Most cases improve with time and use, although significant stiffness may persist and interfere with function. Over the last 20 years, surgical procedures have been reported that can safely improve the range of motion in most patients. A wide variety of different operative procedures and postoperative regimes have been described, with comparable results. Surgical techniques range from arthroscopic procedures, through increasingly extensive open releases, up to those requiring a dynamic external fixator to provide stability. Postoperative passive stretching with manipulation or splinting is often advocated, although evidence of effectiveness is lacking. We provide an overview of the current literature, and propose a new surgical guide to aid with the management of stiff elbows.

Tacrine and suxamethonium were used to produce muscle relaxation in 29 anaesthetized patients. Relaxation was monitored with a nerve stimulator. Post-tetanic facilitation was observed in 24 patients (83 per cent). In spite of this, operating conditions were satisfactory in 26 patients. Poor operating conditions were associated with the more severe degrees of phase II block as judged by an increasingly obvious post-tetanic facilitation. The value of the nerve stimulator and the indications for further doses of tacrine or for changing to an anti-depolarizing relaxant are discussed.

A questionnaire was sent to all centres of cardiac surgery in the United Kingdom, enquiring into their current use of hypothermia. Moderate hypothermia without cardiopulmonary bypass and the Drew technique of profound hypothermia are becoming less popular, each technique being used in only two of the 30 centres which replied. Moderate hypothermia as an integral part of the cardiopulmonary bypass is used on occasions in 24 centres. Although some centres use moderate hypothermia out of habit, the main benefits from its use are considered to be the protection afforded to the myocardium and a greater safety margin in the event of technical difficulties. Profound hypothermia, usually induced by means of the pump oxygenator, followed by circulatory arrest is becoming increasingly popular for the correction of complex congenital anomalies in infants.

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