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Fri Sep 8 23:00:45 BST 2006

I used to anaesthetise this type of operation for Mr Turner-Warwick. 15
hours??????
Maybe the surgeon should get a move on, and finish in half the time.

Dr NJD Macartney MBBS FRCA
Consultant Intensivist
ICU, Chase Farm Hospital, The Ridgeway, Enfield, EN2 8JL
Mob 07831 630068 

  _____  

From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of johan.malmgren at vgregion.se
Sent: 06 September 2006 14:06
To: trauma-list at trauma.org
Subject: OT: Compartment prevention perioperatively

List! 
Would be grateful for some input although a bit off topic. 
20 y/o boy reoperated upon yesterday with a urethroplasty, buccal graft.
Otherwise healthy, I'd guess 1.85 cm/85 kg. 
At earlier similar operation it had been noted a tendency for decubitus, so
everybody took extra precautions. Operation lasted some 15 hours, under
which the legs were lowered a couple of times, and I even think a nurse
massaged them. BP was steady as a rock the entire time, no need for
inotropic drugs. 
Still develops bilateral compartment-syndrome and was bilat fasciotomied
later same night.

The discussion today was of course prevention, and the question raised was
if we should routinely have ortho come and measure pressure perioperatively
during these kind of operations. (I guess the same would apply for some
robotic-surgery operations were the patient almost hangs upside down) On the
other hand, as far as I know, that would tell us when to open his legs and
in an elective case like this, that already seems "too late".
Any ideas? Would be happy to hear what your local routines tells about this!

/Johan Malmgren
MD, Anaesthesia and Critical Care/Trauma

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Compartment prevention perioperatively