Iatrogenic compartment syndrome from hypertonic saline injection in bier block

Mabee, John; Bostwick, Thomas L.; Burke, Mary Kaye

doi:10.1016/0736-4679(94)90342-5

Cited by 26 publications

(15 citation statements)

References 15 publications

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“…These include attempts at obtaining access in the presence of a coagulopathy 2 and arterial catheter removal. 3 Increased tissue pressure with accidental interstitial infusions of packed red cells 4 or normal saline 5 as well as hypertonic saline 6 have also been described. Vascular disruption or catheter malplacement can occur during iv cannulation which may lead to impaired perfusion distal to the injury and increased tissue pressure by the extravasated blood or fluid.…”

Section: Discussionmentioning

confidence: 99%

“…Intravenous administration of blood products 3 hypertonic saline 6 and diazepam 8 have led to or been postulated as a cause of compartment syndrome. Intra arterial injection of phenobarbital 3 has also led to compartment syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…However, compartment syndrome may occur. 6,[17][18][19] In our first case the compartment syndrome had a rapid and severe onset. The second case was less severe.…”

Section: Discussionmentioning

confidence: 99%

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Compartment syndrome following intravenous regional anesthesia

Ananthanarayan

Castro

McKee

et al. 2000

Can J Anesth/J Can Anesth

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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 under iv 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 under iv 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 the iv 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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Compartment syndrome following intravenous regional anesthesia

Ananthanarayan

Castro

McKee

et al. 2000

Can J Anesth/J Can Anesth

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“…Ten patients with compartment syndrome were reported. Inadvertent use of hypertonic saline either used for dilution of the local anesthetic or as a chaser (fluid injected after the local anesthetic) was implicated in 5 of those cases [34][35][36][37][38][39][40] ( Table 2). …”

Section: Major Complications Not Related To Systemic Local Anestheticmentioning

confidence: 99%

Adverse events associated with intravenous regional anesthesia (Bier block): a systematic review of complications

Guay

2009

Journal of Clinical Anesthesia

116

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“…1,2 Injury Extra (2006) 37, 407-408 www.elsevier.com/locate/inext These rare causes bear a superficial relationship with this case. However, we are unaware of any previous report of compartment syndrome specifically related to intramuscular injection of anabolic steroids.…”

Section: Discussionmentioning

confidence: 79%