Background and Aims Anabolic Androgenic Steroids (AAS) abuse surged during the 1980s withaffecting1 in 20 of all males today. A wide spectrum of AAS compounds and abuse regimens are applied and AAS abuse has been associated with an unfavorable cardiovascular profile.

A 23-year-old male with a lower respiratory infection and a previously unknown AAS abuse was admitted to the Cardiac Care Unit (CCU) of the University Hospital of Heraklion due to acute left heart failure (EF:25%). On the second day of hospitalization acute upper limb ischemia developed and a large number of thrombi in the brachial artery was revealed with the use of duplex ultrasonography. Due to his critical condition the anesthetic team decided to perform a left axillary block to proceed the embolectomy.

Methods Axillary block with ropivacaine and lidocaine was performed at the beginning of the surgery. For anxiolysis 1 mg of midazolam was administered. The procedure lasted approximately one hour, while the patient was hemodynamically unstable necessitating a noradrenaline infusion of 0,10 mcg/kg/min.

Results The patient returned to the CCU on a noradrenaline infusion of 0,10 mcg/kg/min. The first postoperative day the patient presented atrial fibrillation treated with digoxin. After 1 month stay at the hospital he was discharged at home.

Conclusions The anesthetists should be able to provide the best care to the patients ongoing surgeries. Peripheral blocks provide the opportunity for critical ill patients to proceed to emergency procedures.