Propofol extravasation: a rare cause of compartment syndrome

Abstract

We detail a rare cause of forearm compartment syndrome that occurred in an 18-year-old patient who presented with a Glasgow Coma Scale of 13/15 after a mixed drug overdose and subsequently required intubation. She suffered extravasation of her propofol infusion, which resulted in intrinsic compression within her forearm muscle compartments. Fortunately, the diagnosis of compartment syndrome was made swiftly and the patient was taken to theatre within 3 h where she underwent an emergency forearm fasciotomy. She made an uneventful recovery and at follow-up her wounds had healed well with no associated morbidity or loss of function. The learning points of this study highlight the importance of thoroughly understanding the signs and symptoms of compartment syndrome while maintaining a high index of suspicion. In addition to a thorough history and examination, consideration of the potential underlying causes allows for a swifter diagnosis and a quicker transition to theatre.

Utility of color flow Doppler ultrasound to identify peripheral intravenous catheter position in adult surgical patients

“…The clinical relevance of our finding of a better performance of color flow Doppler over clinical signs lies in the decision to avoid the administration of medications that can cause serious local tissue damage. [4][5][6] In addition, systemic and local unwanted effects of medications may be the result of a missed diagnosis of vein infiltration. Prolonged neuromuscular block has been reported secondary to accidental subcutaneous deposit of a muscle relaxant.…”

“…Peripherally administered medications such as propofol and vasopressors have been associated with local tissue injury of varying severity. [4][5][6] Confirmation of adequate peripheral intravenous catheter placement should be determined before using the parenteral route; however, there is no gold standard universally accepted for this purpose. Determination of the correct position of freshly inserted peripheral intravenous catheters and already established intravenous lines depends largely on subjective clinical signs such as visual evidence of swelling around the insertion site, low resistance to infusion, and free back-flow of blood.…”

Management of noncytotoxic extravasation injuries: A focused update on medications, treatment strategies, and peripheral administration of vasopressors and hypertonic saline

“…93 In addition to tissue necrosis, compartment syndrome is a serious complication reported in several cases of propofol extravasation, requiring emergent fasciotomies and irrigation. [94][95][96] Although the exact mechanism of tissue injury related to propofol extravasation is unknown, tissue necrosis may be due to direct chemical irritation of skin structures, and large-volume extravasations may lead to tissue ischemia due to high hydrostatic pressures. 97 Regular inspection of the infusion site for swelling, erythema, or signs of compartment syndrome is recommended during procedures or general sedation.…”

Propofol extravasation pain masked by lignocaine premedication

“…There have been numerous reports of propofol extravasation in the literature with sequelae ranging from local erythema to tissue necrosis and compartment syndrome [3][4][5]. In all published cases, propofol extravasation involved patients who were unable to voice pain (anesthetized, sedated or neonate).…”