Hypertrophic cardiomyopathy--a matter of genes.

CAN J ANESTH 55: 5 www.cja-jca.org May, 2008 outcome of the infraclavicular brachial plexus blocks. At our institution, instead of making use of “three factors,” we utilize one common endpoint to ensure the success of the blocks. It is the deposition of the local anesthetic (LA) around the brachial plexus cords. We believe that having the LA “bathe” the nerves is important in predicting the success of the blocks. The U-shaped distribution of LA and the anterior displacement of the artery are often seen as a result of the correct deposition of the LA. Fascial click, however, is sometimes felt twice during the blocks. One click is always felt as the needle pierces the neurovascular sheath, and the second click is sometimes felt as it passes through the septum. Dr. Lévesque writes, “... we need to think in terms of the diffusion compartment, instead of focusing on pure needle-to-nerve distance”. We, too, feel that observing the appropriate LA spread is far more important than having the block needle near the nerve at the beginning of the block. Sinha et al.1 have previously reported that the presence of nerve stimulation had no impact on the success of the resulting blocks. Not only does the ultrasound technology allow us to locate the target structures, it also allows us to direct the needle and to observe the real-time LA spread. Ultimately, this know-how should lead to safer and more effective blocks.