A 25-year-old man presented for revision of a dialysis fistula in his left upper arm. An ultrasound-guided left supraclavicular block was performed, and 4 hours later during wound closure, the patient developed intermittent airway obstruction accompanied by edema of the face and upper airway. Superior vena cava syndrome was suspected, and awake fiberoptic tracheal intubation was performed. Partial obstruction of the left brachiocephalic vein and right internal jugular vein were identified while the patient was in the radiology suite. Sympathetic block and increased venous return from the left arm likely contributed to his airway obstruction that mimicked superior vena cava syndrome.
From the Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland.
Accepted for publication October 4, 2013.
The authors declare no conflicts of interest.
Address correspondence to Paul E. Bigeleisen, MD, Department of Anesthesiology, University of Maryland School of Medicine, 22 South Greene St., Baltimore MD 21201. Address e-mail to Pbigeleisen@anes.umm.edu.