We report the anaesthetic management of an eight-year-old asthmatic bo
y with Bartter's syndrome who had bilateral orchidopexy with caudal ep
idural analgesia. Bartter's syndrome is a rare congenital disorder cha
racterized by hypokalaemic hypochloraemic metabolic alkalosis hyperald
osteronism, hyperreninaemia and hyperplasia of the juxtaglomerular app
aratus of the kidneys. Characteristically, although these patients are
normotensive they may be hypovolaemic. They may have unstable barorec
eptor responses and show marked resistance to vasopressors. Hence, flu
id, acid-base and electrolyte imbalances along with haemodynamic insta
bility pose particular problems in their anaesthetic management. Previ
ous case reports have described the management of these patients with
general anaesthesia, our patient had his orchidopexy with caudal epidu
ral analgesia using plain bupivacaine 0.5%. The patient was haemodynam
ically stable throughout surgery and was comfortable with caudal analg
esia as the sole anaesthetic. Hypovalaemia, acid-base status and elect
rolyte imbalance were treated before instituting caudal epidural analg
esia. We present this care report which describes the anaesthetic cons
iderations in the light of the pathophysiology of Bartter's syndrome.