Routine monitoring of arterial pressure in a brain AVM during embolisation: a diagnostic tool

Identification of normal cerebral arteries in the vicinity of a cerebral arteriovenous malformation [AVM] is essential in order to minimize the risk of morbidity and mortality related to the procedure. The identification of these arteries depends on the skill and experience of the Interventionist. When the angio-architecture is complex or unclear, routine monitoring of cerebral arterial pressure may be a useful tool to assist the Interventionist, especially the less experienced one. In a patient with a remnant high flow brain AVM, a pressure recording in a distal artery immediately before an intended deposit of glue revealed an unexpectedly high pressure of 61 mmHg compared to previously recorded pressures of 29 mmHg in a distal feeder and 21 mmHg in the nidus, indicating that the vessel may not only be feeding the AVM but also supplying brain parenchyma making it unsuitable for embolisation

problem of bupivacaine [marcaine]

The use of bupivacaine [marcaine [R]] in obstetric analgesia and in i.v. regional analgesia [Bier' block] has recently been the subjects of many articles and editorials in medical and lay press. Recommendations on the use bupivacaine have been made by some drug regulatory authorities without significant consultation. Toxic reactions can follow the use of any local anaesthetic and users of any of these drugs must recognize the warning signs of toxicity and be able to resuscitate patients adequately and properly. Bupivacaine is the drug of choice for obstetric epidural analgesia but should not be used in a concentration of greater than 0.5%. It should not be used in Bier's block