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Canadian Journal of Anaesthesia

, Volume 47, Issue 11, pp 1094–1098 | Cite as

Compartment syndrome following intravenous regional anesthesia

  • Chidambaram Ananthanarayan
  • Carmencita Castro
  • Nancy McKee
  • George Sakotic
Clinical Reports

Abstract

Purpose: To present two cases of upper extremity compartment syndrome following intravenous regional anesthesia.

Clinical features:Case 1: A 57-yr-old man presented for surgical release of a left-hand Dupuytren’s contracture. The procedure was performed underiv regional anesthesia with 360 mg lidocaine and sedation with 150 µg fentanyl and 1.5 mg midazolam. Tourniquet time was 107 min at a pressure of 260 mmHg using three different tourniquet sites. Within minutes of tourniquet release, increased forearm muscle tension, hand anesthesia, pallor, and limited motor function developed. Serum CK and myoglobin levels rose. Myoglobinuria was present. Several fasciotomies and aggressive fluid therapy were performed. Patient made almost full recovery.

Case 2: A 73-yr-old woman with controlled hypertension had Dupuytren fasciotomy of her right hand underiv regional anesthesia with 200 mg lidocaine and sedation using 75 µg fentanyl and 1.5 mg midazolam. Tourniquet time was 64 min at a pressure of 250 mmHg using three different tourniquet sites. The patient complained of pain at theiv site during injection of local anesthetic, third tourniquet inflation and after deflation of tourniquet. Thirty minutes after arrival in PACU, her fingers were bluish. She complained of pain and swelling of the forearm. Under general anesthesia, fasciectomy was performed. Myoglobin and CPK levels rose. CPK MB was high but troponin was negative. Three days later she developed pulmonary embolism. She was heparinized and subsequently discharged home. She recovered completely.

Conclusion: Compartment syndrome may have a rapid and severe onset. Etiology of our cases is still not established. We postulate that increased tissue pressure may be the cause. The anesthesiologists must be aware of compartment syndrome during regional anesthesia.

Keywords

Compartment Syndrome Malignant Hyperthermia Tissue Pressure Tourniquet Time Tourniquet Inflation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif: Présenter deux cas de syndrome compartimental du membre supérieur apparu après une anesthésie intraveineuse régionale.

Éléments cliniques:Cas 1: Un homme de 57 ans devait subir une intervention pour éliminer des contractures de Dupuytren à la main gauche. L’anesthésieiv régionale comportait 360 mg de lidocaïne et la sédation, 150 µg de fentanyl et 1,5 mg de midazolam. Le garrot, maintenu pendant 107 min à 260 mmHg, a été placé à trois endroits différents. Quelques minutes après le relâchement du garrot, on a noté une augmentation de la tension musculaire à l’avant-bras, l’anesthésie de la main, de la pâleur et une limitation de la fonction motrice. On a enregistré des niveaux sériques élevés de CK et de myoglobine et la présence de myoglobinurie. On a réalisé quelques fasciotomies et administré beaucoup de liquides. La récupération a été pratiquement complète.Cas 2: Une femme de 73 ans dont, l’hypertension était contrôlée, a subi une fasciotomie de Dupuytren à la main droite sous anesthésieiv régionale avec 200 mg de lidocaïne, 75 µg de fentanyl et 1,5 mg de midazolam. Le garrot, maintenu pendant 64 min à 250 mmHg, a été placé à trois endroits différents. La malade s’est plainte de douleur au point d’injectioniv pendant l’administration de l’anesthésique local, lors du gonflement du troisième garrot et après le relâchement du garrot. Trente minutes après son arrivée à la salle de réveil, ses doigts étaient bleuâtres. Elle présentait de la douleur et de l’enflure à l’avant-bras. Une fasciectomie a été réalisée sous anesthésie générale. Les niveaux de myoglobine et de CPK se sont élevés, mais la troponine était négative. Trois jours plus tard, la patiente a présenté une embolie pulmonaire. Elle a été héparinisée et a pu quitter l’hôpital. Elle a connu une complète récupération.

Conclusion: Le syndrome compartimental peut être sévère et survenir rapidement. L’étiologie de nos cas est toujours inconnue, mais nous pensons à une augmentation de la pression tissulaire. Il faut savoir que le syndrome compartimental peut se développer pendant l’anesthésie régionale.

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Copyright information

© Canadian Anesthesiologists 2000

Authors and Affiliations

  • Chidambaram Ananthanarayan
    • 1
  • Carmencita Castro
    • 1
  • Nancy McKee
    • 2
  • George Sakotic
    • 1
  1. 1.From the Department of AnaesthesiaUniversity of Toronto, Mount Sinai HospitalTorontoCanada
  2. 2.Department of SurgeryUniversity of Toronto, Mount Sinai HospitalTorontoCanada

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