Reversal of central nervous system and cardiac toxicity after local anesthetic intoxication by lipid emulsion injection.

A 91-yr-old man (57 kg, 156 cm, ASA III) received an infraclavicular brachial plexus block for surgery of bursitis of the olecranon. Twenty minutes after infraclavicular injection of 30 mL of mepivacaine 1% (Scandicain) and 5 min after supplementation of 10 mL of prilocaine 1% (Xylonest) using an axillary approach, the patient complained of agitation and dizziness and became unresponsive to verbal commands. In addition, supraventricular extrasystole with bigeminy occurred.

High-resolution ultrasound-guided high interscalene plexus block for carotid endarterectomy.

Background And Objectives: High-resolution ultrasound imaging (HRUI) allows real-time visualization of peripheral nerves, needle insertion, and the spread of local-anesthetic (LA) solution. We evaluated the feasibility of performing a high interscalene brachial-plexus block for carotid endarterectomy by means of HRUI, thereby limiting the amount of LA to the dose required to sufficiently surround the relevant nerve structures.

Methods: The interscalene brachial plexus was localized in the interscalene groove at its most cephalad point in 14 patients undergoing carotid endarterectomy by use of an ultrasound device with a 17.

Congenital pernicious anemia: report of seven patients, with studies of the extended family.

Seven children ages 1 1/2 to 12 years with congenital pernicious anemia were detected in an extended Mexican family. All affected children had megaloblastic anemia accompanied by low serum B12 and normal serum folate levels. Gastric fluid analysis in six patients revealed normal gastric acidity and absent intrinsic factor.