We present four patients in whom a "ketofol" (ketamine 200 mg and propofol 200 mg) infusion was used in conjunction with regional anaesthesia. The patients were considered 'high risk' due to their medical condition or age. The ketofol proved safe and effective in all four cases. Advantages of this technique included analgesia, airway preservation, maintenance of spontaneous respiration, haemodynamic stability and rapid recovery.

Neuromuscular blocking agents are often avoided in anticipated difficult airway scenarios. However, to facilitate jet ventilation, muscle relaxants are useful. We report a case of a potentially threatened airway in a 21-year-old with a large infraglottic pedunculated polyp. In this case rocuronium was used on induction to facilitate subsequent jet ventilation and periglottic laser ablation of the tumour. As the duration of the surgery was not predictable, the intention was to use sugammadex at the end to ensure complete reversal of muscle relaxation. This strategy also provided a quick rescue option if there was a sudden loss of the airway.

A 39-year-old female presented for elective bilateral thoracoscopic splanchnicectomy for chronic severe visceral pain. Surgery and anaesthesia were uneventful and she gained good symptomatic relief. Postoperative recovery was complicated by the development on day four of bilateral herpes zoster at the T8 dermatome level. This was treated immediately with oral acyclovir. She subsequently developed severe post-herpetic neuralgia requiring the recommencement of gabapentin and amitriptyline. Further benefit was gained from a course of calcitonin. This case report examines the possible causative factors in the development of post-surgical herpes zoster.

We present a case of presumed central anticholinergic syndrome due to a drug administration error. A 35-year-old woman was slow to emerge from anaesthesia for laparoscopic biliary surgery. Postoperative neurological and metabolic abnormalities were later diagnosed as central anticholinergic syndrome. Only after resolution of the clinical problems did the drug error origin of the syndrome become apparent. It was realized that hyoscine hydrobromide (scopolamine) had been inadvertently administered intraoperatively for biliary relaxation, instead of hyoscine butylbromide. This case report describes central anticholinergic syndrome and highlights potential problems involved for anaesthetists administering drugs they do not commonly use.