An ASA III patient presenting with a voluminous hemodialysis fistula aneurysm at the elbow was scheduled for its resection. Axillary brachial plexus block was performed under ultrasound and neurostimulation guidance. Despite unexpected nerve positions in relation to pathological vascular anatomy, this combined approach resulted in an adequate block with a low volume of local anesthetic, without obvious vascular puncture or intraneural injection.

Inherited factor VII (FVII) deficiency is a rare autosomal-recessive bleeding disorder. There are no clear guidelines regarding therapy in such patients when intracerebral surgery is performed. We report the use of recombinant activated FVII (rFVIIa) for the prophylaxis of bleeding in a female with FVII deficiency (8% of activity) undergoing urgent removal of a right fronto-rolandic intracerebral haematoma secondary to a bleeding from a cavernous angioma. To assist haemostasis during and after surgery, rFVIIa boluses were administered during the procedure and continued every 12 h during 3 days after operation to maintain a prothrombin time <15 s. Using this approach, no abnormal bleeding or thromboembolic complications were observed and rFVIIa appeared safe in this context.