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Revista Cubana de Anestesiología y Reanimación

2014, Number 2

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Revista Cubana de Anestesiología y Reanimación 2014; 13 (2)

Compartment syndrome after extracorporeal circulation

Nodal LPE, Díaz LJ, Rodríguez SFL, Cierna IJA, Cruz MA, Hernández ME

Language: Spanish
References: 20
Page: 168-175
PDF size: 132.06 Kb.


ABSTRACT

Introduction: Compartment syndrome associated to cardiovascular surgery may result from various factors, among them the ischemia-reperfusion phenomenon following a period of extracorporeal circulation and prolonged aortic clamping, especially when the femoral vessels are cannulated.
Objective: Present a clinical case of compartment syndrome after extracorporeal circulation.
Method: A male 28-year-old patient with a history of cardiac surgery underwent prosthetic aortic replacement once again due to prosthetic valve incompetence. Cannulation was performed during surgery via the right femoral artery and vein to set up extracorporeal circulation, with prolonged cardiac arrest and extracorporeal circulation time. Cerebral protection measures were taken with the use of deep hypothermia, and the patient was transferred to the therapy ward ventilated and under the effect of anesthetics. After recovery and extubation, the patient referred intense pain on his right lower limb, whose volume had gradually increased, especially the posterior region of the leg, which turned tense, with reduced pedal pulses and thermal gradient. An increase in serum potassium was also observed, which was treated energetically, as well as very high CPK values, myoglobinuria and oligonuria, all of which were approached in compliance with the renal protection protocol. The patient's condition was diagnosed as compartment syndrome, and an assessment was requested from the Angiology Service. The diagnosis was confirmed and decompressive fasciotomy was performed. The patient evolved favorably and the affected limb was preserved.
Conclusions: Early diagnosis and management make it possible to limit and reduce the complications of compartment syndrome.


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