Popliteal Vein Compression Under General Anaesthesia

Abstract

Knee hyperextension in supine patients during general anaesthesia leads to popliteal vein compression or occlusion. The likelihood of compression increases with higher BMIs.

Functional Popliteal Entrapment Syndrome in the Sportsperson

“…These findings are consistent with the concept of normal muscle pump function. The medical literature suggests that the pathological state may exist with the knee hyperextended (supine) 11,12 or when the knee is locked (standing). 13 The pathophysiology arises with the hypertrophy of the calf muscles required to power the increased body mass.…”

A comparative assessment of interface pressures generated by four surgical theatre heel pressure ulcer prophylactics

“…Offloading the heel with current offloading devices allows the knee to drop back unsupported. This causes popliteal vein compression, particularly in supine anaesthetised patients (9,11). This in turn is thought to increase the likelihood of DVT (9,11).…”

“…Devices that are currently in use for the prevention of heel and ankle pressure ulcers either offload (such as the Oasis) or cradle the heel (Action ® heel block) or try to distribute the pressure on a pad such as a viscose elastic gel (VEG) mat. Heel offloading devices allow the knee to drop back and this causes popliteal vein compression in up to 64% of supine and anaesthetised patients (9). A prototype elevation device has been designed specifically for use in the operating theatre and to satisfy the requirements of the EPUAP/NPUAP consensus statement (1).…”

Guideline for positioning the patient

“…Perioperative personnel should use a heel-suspension device to prevent pressure injury to the heels and hyperextension of the patient's knees, which compresses the popliteal vein and increases the patient's risk of developing deep vein thrombosis. 6 The tilt of the OR bed in the Trendelenburg position should be minimized as much as possible; for example, a 30-to 45-degree OR bed tilt is generally considered a steep angle. 1 Greater degrees of Trendelenburg position can augment physiological strain on the patient's body and increase the potential for complications, such as intracranial hypertension and respiratory deterioration.…”