Regional analgesia for lower leg trauma and the risk of acute compartment syndrome: Guideline from the Association of Anaesthetists.

Pain resulting from lower leg injuries and consequent surgery can be severe. There is a range of opinion on the use of regional analgesia and its capacity to obscure the symptoms and signs of acute compartment syndrome. We offer a multi-professional, consensus opinion based on an objective review of case reports and case series. The available literature suggested that the use of neuraxial or peripheral regional techniques that result in dense blocks of long duration that significantly exceed the duration of surgery should be avoided. The literature review also suggested that single-shot or continuous peripheral nerve blocks using lower concentrations of local anaesthetic drugs without adjuncts are not associated with delays in diagnosis provided post-injury and postoperative surveillance is appropriate and effective. Post-injury and postoperative ward observations and surveillance should be able to identify the signs and symptoms of acute compartment syndrome. These observations should be made at set frequencies by healthcare staff trained in the pathology and recognition of acute compartment syndrome. The use of objective scoring charts is recommended by the Working Party. Where possible, patients at risk of acute compartment syndrome should be given a full explanation of the choice of analgesic techniques and should provide verbal consent to their chosen technique, which should be documented. Although the patient has the right to refuse any form of treatment, such as the analgesic technique offered or the surgical procedure proposed, neither the surgeon nor the anaesthetist has the right to veto a treatment recommended by the other.

Neurological sequelae following a high voltage electrical burn.

Neurological complications secondary to electrical injury can manifest themselves either early or late. A small percentage of these patients develop delayed peripheral neuropathy. However, patients experiencing transient spinal cord symptoms have been described. We describe the development of a lower motor neurone syndrome affecting all the limbs in a patient following a significant electrical injury, which although expected to cause spinal cord necrosis showed no evidence of this on magnetic resonance imaging. The fact that neurophysiology was unable to localize the problem made this case all the more perplexing. Similar cases reported in the literature are discussed.

A survey of emergency airway management in the United Kingdom.

A postal questionnaire aiming to ascertain the availability of cricothyrotomy and transtracheal ventilation equipment, and experience of its use, was sent to all tutors of the Royal College of Anaesthetists in the United Kingdom and Ireland. The response rate was 74.9%. Almost half of the respondents had experience of cricothyrotomy. The 'Portex Minitrach' (58.6%) was the most commonly used preformed device, followed by the 'William-Cook' cannula (8.5%). The 14-G intravenous cannula (21.1%) was the most frequently improvised cricothyrotomy device. Seventy six percent of all theatres had equipment available for such emergency airway management. Sixty five percent of Portex-Minitrach insertions resulted in complications, more than half of which were serious (total failure to cannulate (17.1%), multiple attempts (20.7%), pneumothorax (8.5%) and severe bleeding (7.3%)). Major complication rates of the 'William-Cook' device and 14-G intravenous cannula were 27.3% and 22.2% respectively. Seventy five percent of patients reported had eventual successful airway management with full recovery, while 9.6% had partial recovery and 15.4% died. Formal training of emergency airway management was practised in 14.2% of anaesthetic departments, while 73.6% had informal training. Twelve percent of the departments did not specifically teach their trainees the skill of emergency airway management.