Children with anterior mediastinal masses may experience serious complications during general anaesthesia. We retrospectively surveyed the records of children with an anterior mediastinal mass who had been admitted to our hospital over a 7 year period. The presence of pre-operative symptoms or signs, findings of any special investigations performed and the anaesthetic outcome were noted. All radiological investigations were studied and tracheal compression measured. The majority of patients presented with severe clinical signs. There was a poor relationship between clinical signs and size of tumour or tracheal compression on CT scan. Corticosteroids were used prior to diagnosis in 33% of patients, all of whom were considered high risk. A clear diagnosis was made in 95% of these patients. The overall complication rate was 20% and 5% of patients had a serious complication related to anaesthesia. Stridor was the only sign that predicted an anaesthetic complication. Peri-operative respiratory complications were confined to patients with an isolated tracheal cross-sectional area less than 30% normal or less than 70% and associated with bronchial compression.

The case of a 6-year-old boy who developed complications following gastric interposition surgery for severe, recurrent esophageal stricture is reported. Investigation of his pleural effusion revealed a rare and unexpected complication.

The unbound and bound plasma concentration of bupivacaine in 50 infants less than 55 weeks postconceptual age was determined following combined spinal and epidural anaesthesia (CSEA). Plasma concentrations were determined at 15‐min intervals up to 60 min postspinal anaesthesia. Maximum plasma bupivacaine levels were recorded between 45 and 60 min post CSEA. Total plasma concentrations above a toxic threshold level of 4 μg·ml−1 were recorded in 4% of patients and above 2.5 μg·ml−1 in 10% of patients. Unbound bupivacaine levels were greater than a presumed toxic level of 0.25 μg·ml−1 in 16% of cases and above 0.3 μg·ml−1 in 14% of cases. A wide range of protein binding was measured (varying from 53.8–98.2%) and could not be correlated with standard indicators of local anaesthetic binding. Two neonates had brief apnoeas in the immediate perioperative phase but no adverse cardiac or central nervous system events attributable to the performance of CSEA were demonstrated.