Impending compartment syndrome of the forearm and hand after a pressurized infusion in a patient under general anesthesia -A case report-

Abstract

A 74-year-old woman underwent posterior lumbar decompressive fusion at L4-5 for treating spondylolisthesis, with the patient under general anesthesia and she was in the prone position. Following attempts to transfuse blood using a pressurized bag, the intravenous infusion site of the left hand along with the noninvasive blood pressure cuff was changed. Swelling and several bullae on the left forearm and hand were visible. Removal of intravenous catheter, hyaluronidase injection, wet dressing were subsequently performed. In postanesthesia recovery unit, the patient did not complain of pain, and the radial pulse and oxygen saturation of the left appeared normal. Three days after the incident, the edema on the patient's forearm and hand subsided, and the patient was discharged without any complications two weeks afterwards. Impending compartment syndrome should be given close attention, and particularly when performing pressurized infusion in patients who are unable to express pain because they are under general anesthesia.

The properties of an improvised piston pump for the rapid delivery of intravenous fluids

“…There have been case reports of extravasation and compartment syndrome caused by bulb pumps, with saw‐tooth pressure profiles . However, there are similar reports relating to inflatable pressure cuffs and even rapid infusers with occlusion alarms . Cannula site vigilance is thus advised irrespective of pressurisation method.…”

Comparison of the effectiveness of the piston-pump method versus the pressure-infusor method for rapid infusion of fluids

“…Thus, neither the piston-pump method nor the pressure-infusor method will cause barotrauma. However, there have been some case reports of extravasation and compartment syndrome resulting from pressurized infusion [3][4][5][6]. Moreover, even if the cannula is placed appropriately in a vein and the proximal run-off from the vein is occluded, the venous pressure can increase markedly [11].…”

“…However, several problems have been pointed out in the piston-pump method. First, attempting a rapid push of the piston generates the excessive positive intravenous pressure, which is di cult to regulate and can lead to barotrauma [3][4][5][6]. Second, negative pressure occurs when withdrawing the syringe plunger before re lling, which may hemolyse red blood cells [1,7].…”

Compartment syndrome due to extravasation of peripheral parenteral nutrition: extravasation injury of parenteral nutrition

“…It is most commonly associated with trauma, although cases of nontraumatic and iatrogenic origin are increasing 2) . There are many iatrogenic causes, including the use of a tourniquet 2) , pressurized infusion pumps 3) , extravasation of various kinds of medications 2 4) , and anticoagulation therapy 2) . One of the iatrogenic causes of compartment syndrome, extravasation injuries, occurs under a wide variety of circumstances in the inpatient setting 2) .…”