Bilateral compartment syndrome complicating prolonged lithotomy position

Tuckey, J.

doi:10.1093/bja/77.4.546

Cited by 66 publications

(44 citation statements)

References 25 publications

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“…Bilateral CS has been frequently described in pro- longed, more than 6 hours, lithotomy position [4][5][6][7] . This event is rarely related to a surgical procedure in supine position 8 .…”

Section: Discussionmentioning

confidence: 99%

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Peroneal nerve palsy due to compartment syndrome after facial plastic surgery

Godeiro-Júnior

Oliveira

Felı́cio

et al. 2007

Arq. Neuro-Psiquiatr.

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-A 25-year-old white man, right after bilateral rhytidoplasty, presented with agitation, necessiting use of haloperidol. Some hours after, he developed severe pain in his legs and a diagnosis of neuroleptic malignant syndrome (NMS) was considered. Even with treatment for NMS he still complained of pain. A diagnosis of lower limb compartment syndrome (CS) was done only 12 hours after the initial event, being submitted to fasciotomy in both legs, disclosing very pale muscles, due to previous ischemia. This syndrome was not explained only by facial surgery, his position and duration of the procedure. It can be explained by a sequence of events. He had a history of pain in his legs during physical exercises, usually seen in chronic compartment syndrome. He used to take anabolizant and venlafaxine, not previously related, and the agitation could be related to serotoninergic syndrome caused by interaction between venlafaxine and haloperidol. Rhabdomyolisis could lead to oedema and ischmemia in both anterior leg compartment. This report highlights the importance of early diagnosis of compartment syndrome, otherwise, even after fasciotomy, a permanent disability secondary to peripheral nerve compression could occur.KEY WORDS: compartment syndrome, plastic surgery, rhytidoplasty, peroneal nerve.Paralisia de nervo fibular devido a síndrome compartimental após cirurgia plástica da face RESUMO -Logo após ritidoplastia bilateral, um jovem de 25 anos apresentou agitação, necessitando uso de haloperidol. Algumas horas após, desenvolveu dor intensa em membros inferiores, e o diagnóstico de sín-drome neuroléptica maligna foi considerado. Mesmo com o tratamento para tal, persistiu com dor. Após 12 horas do início do quadro, foi realizado o diagnóstico de síndrome compartimental de membros inferiores e o jovem foi submetido a fasciotomia bilateral. Uma seqüência de eventos desencadeou esta sín-drome, já que sua ocorrência dificilmente seria justificada pela cirurgia facial e/ou posição do paciente durante o procedimento. O jovem apresentava previamente dor em membros inferiores aos exercícios, sugerindo a ocorrência de uma síndrome compartimental crônica. Ele fazia uso de anabolizantes e venlafaxina, não relatado no início do quadro, e a agitação poderia ser explicada por uma síndrome serotoninérgia desencadeada pela interação deste último medicamento e haloperidol. A rabdomiólise secundária a estes eventos causou edema e isquemia nos compartimentos anteriores de ambos os membros inferiores, levando a uma compressão secundária do nervo fibular. O caso em questão ilustra a importância do diagnósti-co precoce da síndrome compartimental pois, caso contrário, mesmo com fasciotomia, uma complicação permanente devido à compressão de nervos periféricos pode se estabelecer. PALAVRAS-CHAVE: síndrome compartimental, cirurgia plástica, ritidoplastia, nervo fibular. Compartment syndrome (CS) develops when pressure within closed osseofascial compartments increases, reducing capillary perfusion gradient, leading to cellular anoxia and ...

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“…Bilateral CS has been frequently described in pro- longed, more than 6 hours, lithotomy position [4][5][6][7] . This event is rarely related to a surgical procedure in supine position 8 .…”

Section: Discussionmentioning

confidence: 99%

“…Several etiologies for CS have been described in the literature but the leading cause is posttraumatic injury [1][2][3] . Long-duration surgeries (urological, colorectal, and gynecological procedures) in lithotomy position are recognized causes of CS [4][5][6][7][8] . There are few reports on CS during prolonged supine surgeries.…”

mentioning

confidence: 99%

Peroneal nerve palsy due to compartment syndrome after facial plastic surgery

Godeiro-Júnior

Oliveira

Felı́cio

et al. 2007

Arq. Neuro-Psiquiatr.

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“…16 It typically follows traumatic injury, but may also occur after ischaemic reperfusion injuries, 17 burns, 18 prolonged limb compression after drug overdose 19 or poor positioning during surgery. [20][21][22][23][24] Furthermore, subclinical compartment syndromes may explain the occurrence of a variety of postoperative disabilities which have been identified after the treatment of fractures of long bones using intramedullary nails. 25 Approximately 40% of all acute compartment syndromes occur after fractures of the tibial shaft 26 with an incidence in the range of 1% to 10%.…”

Section: Aetiologymentioning

confidence: 99%

“…Although the absolute pressure is diminished by relieving soft-tissue swelling, 46 high elevation also reduces the arteriovenous pressure gradient and renders the tissues less tolerant to raised intracompartmental pressures. 47 This may partially explain the occurrence of the syndrome after the lithotomy 23 and hemilithotomy 20,24 positions which are used in certain surgical procedures.…”

Section: Clinical Assessmentmentioning

confidence: 99%

Diagnosing Acute Compartment Syndrome

Elliott

Johnstone

2003

The Journal of Bone and Joint Surgery. British volume

315

243

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“…Intracompartment pressure monitoring (ICP) is considered as a "gold standard" for ACS diagnosis and for decompressive fasciotomy indication 5,14,16,24,27 . The normal intracompartment pressure is in between 0-8 mmHg or below 10-12 mmHg according to different data 9,[28][29][30] . Pain is common with the ICP pressure over 20 mmHg and pressure over 30 mmHg is considered to be indication for emergency fasciotomy 8,10,27,31,32 , but the precise value varies in the literature between 30-45 mmHg [33][34] .…”

Section: Introductionmentioning

confidence: 99%