The implantation of cardiac devices (pacemakers) is often performed through invasive cardiologists under painful conditions for the patients lacking the knowledge of specific regional anesthesia. To rescue this situation, physicians are forced to use (i) sedation for the patients and (ii) tons of regional anesthesia like 500mg Prilocaine. We followed the idea of specific regional anaesthesia using ultrasound-guided pectoralis blockage 1 (PECS1 block: 10ml Ropivacaine 0.5%) and compared this approach with commonly used regional anesthesia on individuals with the indication for cardiac pacemaker implantation. We found significant less pain sensations using the PECS1 block during the operation procedure. US guided PECS1 block is a safe and completely useful tool in the Cath lab to proceed with cardiac device implantations.

Background: High volume intensive care units with high expertise on respiratory distress syndromes are familiar with extracorporeal CO 2 elimination procedures in regard to their maintenance. In contrast, small intensive care units offer a lack of this experience. So, a novel approach (passive, invasive, without any further specification) plugs this lack of experience.Case Report: A 60 years old male patient in poor health conditions was presented to our small intensive care unit due to shortness of breath in regard to bilateral pneumonia in septic shock. Sedated and intubated, we monitored blood gas analyses and observed pCO 2 problems, raising to 150mmHg with stable pO 2 85mmHg. We used interventional arteriovenous lung assist system iLA (Novalung®, Heilbronn, Germany) and improved respiratory conditions by reduction of pCO 2 to normal levels constantly for 10 days. Using iLA (Novalung®) on our small ICU we healed passively and invasively the patient for discharging on day 15. Conclusion:This case report clearly demonstrates the unspectacular use of the highly effectual passive and invasive CO 2 elimination system iLA, Novalung® (Heilbronn, Germany) even on a small intensive care unit of a hospital for basic and regular care in Germany.