ABSTRACT
Pain management in trauma or surgery with a high risk of developing compartment syndrome (CS) is always challenging due to fears of masking symptoms that could delay diagnosis and treatment. Regional anesthesia/analgesia (RA) can facilitate enhanced postoperative recovery and improve patient satisfaction by providing excellent postoperative analgesia. However, its consideration in surgeries with a high risk of developing CS remains controversial and contentious. Studies suggest focusing more on early diagnosis through regular vigilant monitoring with a high index of suspicion rather than discontinuing the analgesic method alone. The most consistent features in all reported cases of CS were altered sensation in the affected limb, disproportionate pain in the presence of a functional nerve block, and an escalating need for analgesics. Several extrinsic or intrinsic factors are responsible for the progressive increase in compartment pressure that can lead to vascular compromise and subsequent ischemic changes in muscles, tissues, and nerves. Measurement of intracompartmental pressure (ICP) has always been considered the gold standard for diagnosing CS. An ICP of 30 mm Hg is considered the cut-off point for fasciotomy that helps restore muscle perfusion and avoid irreversible tissue damage. The chronology of symptoms can sometimes provide clues to the severity of CS, the pathophysiology involved, and the management required. Therefore, it is necessary to look for warning signs, further investigate the causes, and make quick decisions to diagnose and treat CS and its complications on time. Any delay in the diagnosis and treatment of CS can result in high morbidity and poor outcomes. A well-integrated interprofessional team of health professionals can deliver the required complexity of care through a holistic and multidisciplinary approach. This review article highlights the symptoms, risk factors, and pathophysiology involved in CS. It can guide readers in choosing various options to diagnose, prevent, and treat CS. It also discusses the role of RA in patients or surgeries prone to developing CS.
ABSTRACT
Lymphatic cyst in the cervical region presents a great challenge to the anesthesiologist. The anesthetic difficulties are because of the extension of the cyst, difficult airway, postoperative respiratory obstruction, and coexisting anomalies. The management of such patients depends on direct communication between the surgeon and anesthesiologist. We hereby present a case of a 53-year-old male presenting with lymphatic cyst of the cervicothoracic region with dysphagia and dyspnea, posted for direct laryngoscopy and biopsy under general anesthesia. Awake fiberoptic intubation was done in this patient successfully in spite of totally distorted airway anatomy.
Résumé Le kyste lymphatique dans la région cervicale présente un grand défi pour l'anesthésiste. Les difficultés anesthésiques sont dues à l'extension du kyste, des voies respiratoires difficiles, une obstruction respiratoire postopératoire et des anomalies coexistantes. La prise en charge de ces patients dépend de communication directe entre le chirurgien et l'anesthésiste. Nous présentons ici le cas d'un homme de 53 ans présentant une atteinte lymphatique kyste de la région cervicothoracique avec dysphagie et dyspnée, posté pour laryngoscopie directe et biopsie sous anesthésie générale. Éveillé l'intubation par fibre optique a été réalisée avec succès chez ce patient malgré une anatomie des voies respiratoires totalement déformée. Mots-clés: Hygroma kystique, voies aériennes difficiles, intubation fibre optique.
