Bilateral brachial plexus blocks in a patient of hypertrophic obstructive cardiomyopathy with hypertensive crisis.

Hypertrophic obstructive cardiomyopathy (HOCM) is a challenge to anesthesiologists due to the complex pathophysiology involved and various perioperative complications associated with it. We present a 50-year-old man, a known case of HOCM, who successfully underwent emergency haemostasis, and debridement of the traumatically amputated right upper limb and the contused lacerated wound on the left forearm under bilateral brachial plexus blocks. His co-morbidities included hypertension (in hypertensive crisis) and diabetes mellitus. He was full stomach and also had an anticipated difficult airway. The management included invasive pressure monitoring and labetalol infusion for emergent control of blood pressure. The regional anaesthesia technique required careful consideration to the dosage of local anaesthetics and staggered performance of brachial plexus blocks on each of the upper limbs to avoid local anaesthetic toxicity. Even though bilateral brachial plexus blocks are rarely indicated, it seemed to be the most appropriate anaesthetic technique in our patient. With careful consideration of the local anaesthetic toxicity and meticulous technique, bilateral brachial plexus blocks can be successfully performed in those patients where general anaesthesia is deemed to be associated with higher risk.

Bronchospasm following supraclavicular brachial plexus block.

Supraclavicular brachial plexus block is commonly performed for upper limb surgeries. In patients with compromised respiratory function or in the elderly it may be preferred over general anaesthesia. Bronchospasm, albeit a rare complication of this procedure, may turn the advantages of regional anaesthesia in these patients into a disadvantage. Bronchospasm following interscalene approach has been previously reported. However, the same following the supraclavicular approach has not yet been reported. A 70-year-old woman presented with cellulitis of the left upper limb. A successful left brachial plexus block was performed uneventfully via the supraclavicular approach for an emergency debridement. She developed bronchospasm in the post-operative care unit (1 hour after the performance of the block) which responded to the standard treatment and rest of her hospital stay was uneventful. Awareness of possibility of this less known complication is necessary, especially in patients of compromised respiratory function to initiate prompt treatment and avoid further complications.