A total of 139 of 473 severely disabled, mainly ventilator-dependent patients required some form of surgery. Such patients require surgery more frequently than normal individuals, both because of their disability and because even minor unrelated disorders superimposed on permanent disability cause greater handicap. We report the peri-operative management and postoperative complications of 142 operations on 83 patients between 1982 and 1987. A simple inhalational anaesthetic technique was used; opioids and muscle relaxants were seldom given. Negative pressure ventilation was employed in the postoperative period when appropriate, and was combined with vigorous chest physiotherapy. There were three peri-operative deaths, but the overall death rate in the patients who underwent surgery was no greater throughout the study period than in those who did not require surgery. We believe that an aggressive surgical approach is appropriate in severely disabled, ventilator-dependent patients.