Our review suggests that the rate of neurological complications after central nerve blockade is <4:10,000, or 0.04%. The rate of neuropathy after PNB is <3:100, or 3%. However, permanent neurological injury after RA is rare in contemporary anesthetic practice.

OBJECTIVEPeripheral nerve imaging by portable ultrasound (US) may serve as a noninvasive and lower-cost alternative to nerve conduction studies (NCS) for diagnosis and staging of diabetic sensorimotor polyneuropathy (DSP). We aimed to examine the association between the size of the posterior tibial nerve (PTN) and the presence and severity of DSP.RESEARCH DESIGN AND METHODSWe performed a cross-sectional study of 98 consecutive diabetic patients classified by NCS as subjects with DSP or control subjects. Severity was determined using the Toronto Clinical Neuropathy Score. A masked expert sonographer measured the cross-sectional area (CSA) of the PTN at 1, 3, and 5 cm proximal to the medial malleolus.RESULTSFifty-five patients had DSP. The mean CSA of the PTN in DSP compared with control subjects at distances of 1 (23.03 vs. 17.72 mm2; P = 0.004), 3 (22.59 vs. 17.69 mm2; P < 0.0001), and 5 cm (22.05 vs. 17.25 mm2; P = 0.0005) proximal to the medial malleolus was significantly larger. Although the area under the curve (AUC) for CSA measurements at all three anatomical levels was similar, the CSA measured at 3 cm above the medial malleolus had an optimal threshold value for identification of DSP (19.01 mm2) with a sensitivity of 0.69 and a specificity of 0.77 by AUC analysis.CONCLUSIONSThis large study of diabetic patients confirms that the CSA of the PTN is larger in patients with DSP than in control subjects, and US is a promising point-of-care screening tool for DSP.

This animal study suggests that nerve expansion seen on ultrasound during intraneural injection of clinically relevant volumes of LA results in histologic but not functional nerve injury.

Purpose: To describe the presentation and management of complete upper airway obstruction with life threatening arterial oxygen desaturation that occurred during attempted awake fibreoptic intubation in two patients presenting with unstable C-spine injury. Clmic.~ F~tum: Complete upper airway obstruction occurred during awake fibreoptic intubation of two men (ASA II; 68 & 55 yr old) presenting with unstable C-spine fractures. In both cases, bag and mask ventilation with CPAP failed to relieve the progressive hypoxemia. A surgical airway was established urgently to oxygenate the two patients who were suffering progressive life-threatening oxygen desaturation. One patient had t~ns-cricothyroid jet ventilation performed through a 16G intravenous cannula prior to an urgent tracheostomy. In the other patient, an emergency tracheostomy was inserted. Interestingly, both patients had been sedated in the Neurosurgical Intensive Care Unit with morphine and benzodiazepines before their scheduled surgeries. The most likely etiology for the complete upper airway obstruction was laryngospasm due to inadequate topicalization of the airway and additional sedation given in the operating room. Neither patients suffered any new neurological deficits following these events. They went on to have uneventful surgeries. Condmion: This case report suggest that prior to awake fibreoptic intubation, oxygenation, adequate topicalization with testing to verify the lack of pharyngeal and laryngeal responses and careful assessment of sedation levels in the operating room are prudent for a safe endoscopic intubation. Obj~-tif: D&rire le tableau clinique et le traitement de robstruction compl&e des voies a~riennes sup&ieures, accompagn~e d'une dangereuse d&aturation du sang art~riel en oxyg~ne, survenue pendant qu'on tentait une fibroscopie vigile chez deux sujets souffrant d'une instabilit~ de la colonne cervicale. ~ealts dinique~ : Une obstruction complete des voies a&iennes sup&ieures s'est produite pendant une fibroscopie vigile chez deux hommes (ASA II ; 68 & 55 ans) qui pr~sentaient des fractures de la colonne cervicale. Dans les deux c.as, la ventilation manuelle au masque et au ballon et une ventilation spontan& avec pression expiratoire positive (PEP) n'a pu soulager I'hypox~mie progressive. Le r~tablissement chirurgical du conduit a&ien a ~t~ r~alis~ d'urgence pour oxyg~ner les deux patients qui souffraient d'une d~saturation progressive en oxyg~ne rnettant leur vie en danger. On a proc~d& chez run des patients, ~ une ventilation ~ jet transcricothyroidienne au moyen d'une canule intraveineuse 16G avant la trach~otomie d'urgence. Chez I'autre patient, une trach~otomie d'urgence a ~t~ pratiqu&. II est int&essant de rioter que les deux patients avaient re~u une s~dation ~ I'unit~ des soins intensifs neurochirurgicaux avec de la morphine et des benzodiaz~pines avant la chirurgie ~lective. I'~tiologie la plus probable de I'obstruction compl&e des voies a&i-ennes sup&ieures ~tait un laryngospasme caus~ par une puiv&isation inadequate du co...