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Endovascular repair with covered stents has been widely used to treat subclavian and axillary artery injuries and has produced promising early results. The possibility of a thromboembolism occurring in cerebral arteries during an endovascular procedure should be a cause for concern. In the case of endovascular management of arterial traumas, a prompt and sufficient period for check-up of the patient's neurological signs is needed, even if it requires postponing elective intervention for the patient's safety. We report a rare case of liver transplantation immediately after endovascular repair of an iatrogenic subclavian arterial injury to describe the risk of continuing planned surgery without neurologic assessment.

In the pédiatrie ICU and operating room, a central venous catheter (CVC) provides accurate hemodynamic information and sei-ves as a reliable route for the administration of vasoactive drugs, fluids and allogeneic blood products. The placement of CVC is associated with a complication rate of 0.4% to 20%, including hemothorax, pneumothorax, thrombosis, infection and cardiac tamponade. We describe a case of CVC being misplaced in the innominate vein after penetrating the subclavian vein during anesthesia induction for arterial switch operation. Our report discusses the mechanisms by which this mishap took place, and reviews the proper positions of the head, arm, thorax and safe depth of venipuncture for the placement of a CVC in neonates.In the pédiatrie ICU and operating room, the placement of a central venous catheter (CVC) is essential in order to obtain accurate hemodynamic information, and for the administration of vasoactive drugs and fluids. [1,2] Additionally, current therapeutic techniques for the treatment of leukemia, the use of hemodialysis, and the need for long-term parenteral nutrition or antibiotic therapy require large-sized vessels with a high blood flow. Predictable complications of central vein catheterization include arterial puncture, pneumothorax, air embolism, arrhythmia, malpositioning of the catheter and cardiac tamponade. Catheter malposition results in not only faulty central venous pressure measurement but also significant complications such as thrombosis, arrhythmia, cardiac perforation, and cardiac tamponade.

Background:The lower levels of cardiotoxicity and motor block make ropivacaine well suited as an epidural infusion for postoperative analgesia. This study examined the analgesic efficacy of an epidural infusion of ropivacaine alone and in combination with alfentanil after major abdominal surgery.Methods: Thirty patients undergoing major abdominal surgery under general anesthesia were divided into two groups receiving patient-controlled thoracic epidural analgesia with 0.2% ropivacaine (Group I) and 0.15% ropivacaine +150μg/ml alfentanil (Group II). The motor block, side effects, VAS (visual analog pain scale) score on coughing and resting, additional analgesics use, and patient's satisfaction were checked for 24 hours after a loading dose injection.Results: The VAS score in group II was significantly lower than in group I, and the patients in group II were more satisfied than those in group I (P ＜ 0.05). However, there were more side effects in group II.Conclusions: Postoperative epidural infusion of 0.15% ropivacaine with 150μg/ml alfentanil is more effective than 0.2% ropivacaine only.

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