[Generalized seizure during placement of an axillary plexus block]. / Generalisierter Krampfanfall während der Anlage einer axillären Plexusblockade.

A young patient experienced a generalized seizure during the placement of an axillary plexus block. The mechanisms, essentially the presumed intravascular administration, which led to the local anesthetic toxicity as the cause of this event, are discussed. This case is an example of how visualization of the anatomy by ultrasound can give a false impression when certain details are not respected. It is assumed that the main mechanism in this case was venous compression by the ultrasound transducer.

[Actually a routine matter: ischemia after catheterization of the radial artery]. / Eigentlich eine Routinemaßnahme : Ischämie nach A.-radialis-Kanülierung.

A 76-year-old patient developed necrosis of the index finger after placement of a radial artery catheter. This article discusses the risks associated with invasive blood pressure monitoring and treatment options in cases of critical ischemia. The authors conclude that there is no consensus concerning optimal treatment and that a discussion on options for preoperative risk assessment and quickest possible recognition of such complications is worthwhile. Despite the risk of ischemia invasive blood pressure monitoring is an indispensable procedure.

["Diagnostic" interscalene plexus block]. / "Diagnostischer" Interskalenusblock.

The dedicated target region should be systematically examined before performing an ultrasound-guided nerve block so that the anatomy can be assessed and anatomic variants or pathologic findings are not missed. In the case described an ultrasound-guided interscalene plexus block was performed in a 73-year-old man. During this examination a cystic structure was detected within the thyroid gland. The further diagnostic procedure showed a metastasis of a renal cell carcinoma which had been treated by resection 10 years before.

Tumescent anaesthesia in combination with femoral nerve block for surgery of varicose veins: prilocaine 0.1% versus 0.2%.

OBJECTIVE: Results of a prospective, randomized, double-blinded study about tumescent anaesthesia (TA) in combination with femoral nerve block (FNB) for surgery of varicose veins are reported. The aim is to compare two different concentrations of prilocaine in TA. METHOD: With approval of the ethical committee and informed consent, FNB (nerve stimulation, 20 mL prilocaine 0.75%) was performed followed by TA using prilocaine 0.1% versus 0.2% (groups P0.1 and P0.2). Further medication was standardized. Overall amount of prilocaine was recorded, plasma levels of 20 patients measured regularly. Side-effects, patient satisfaction and pain scores were compared (P < 0.05). RESULTS: Ninety patients were included. In one patient (P0.1), general anaesthesia was necessary. There was no difference in pain scores, need for rescue medication or patient satisfaction. More prilocaine was administered in P0.2 (P < 0.0001) with higher but far below toxic plasma levels. In three patients (P0.2) mild met-haemoglobinaemia was confirmed. CONCLUSION: TA with prilocaine 0.1% in combination with FNB is sufficient to provide high patient satisfaction during varicosis surgery.