Fast-Track Cardiac Anesthesia Aids in the Early Diagnosis of Lower Extremity Compartment Syndrome: A Case Report.

A 21-year-old otherwise healthy male with severe asymptomatic mitral regurgitation underwent a mitral valve repair via right thoracotomy and right femoral cannulation for cardiopulmonary bypass. Due to his age and health status, the anesthetic was planned to facilitate early extubation. Immediately on arrival to the intensive care unit, the patient complained of severe right calf pain with decreased sensation of the plantar foot. He was diagnosed with compartment syndrome and was taken back to the operating room for emergent 4-compartment fasciotomy. The fast-track anesthetic allowed for early diagnosis and treatment and prevented a likely catastrophic outcome.

The effects of alcohol on coagulation in trauma patients: interpreting thrombelastography with caution.

BACKGROUND: The effects of alcohol on coagulation after trauma remain unclear. In vitro studies show that alcohol may decrease clot strength and inhibit fibrinolysis. Observational data indicate that alcohol leads to altered thrombelastography (TEG) parameters indicative of impaired clot formation. Clinical studies have been inconclusive to date. METHODS: Longitudinal plasma samples were prospectively collected from 415 critically injured trauma patients at a single Level 1 trauma center and were matched with demographic and outcome data. Citrated kaolin TEG and standard coagulation measures were performed in parallel. Univariate and group comparisons were performed by alcohol status, with subsequent linear and logistic regression analysis. RESULTS: A total of 264 patients (63.6%) had detectable blood alcohol levels (EtOH, >10 mg/dL). These patients were primarily male (87% vs. 79%), were bluntly injured (77% vs. 59%), and had lower median Glasgow Coma Scale (GCS) score (9.5 vs. 14, all p < 0.05) than the EtOH-negative patients. There were no notable differences in pH (7.29 vs. 7.31, p = nonsignificant) or injury severity (median Injury Severity Score [ISS], 11 vs. 14; p = nonsignificant) between the groups. The alcohol-positive patients had a prolonged TEG citrated kaolin R-time (reaction time), or time to initial clot formation (5.91 minutes vs. 4.43 minutes, p = 0.013), prolonged K-time (kinetics time), or time to fixed level of clot strength (1.77 minutes vs. 1.43 minutes, p = 0.036), and decreased α angle (66.5 degrees vs. 70.2 degrees, p = 0.001). In multiple linear regression, for every 10-mg/dL increase in EtOH, R-time was prolonged by 3.84 seconds (p = 0.015), and α angle decreased by 0.11 degrees (p = 0.013). However, in multiple logistic regression analyses, EtOH was a negative predictor of coagulopathy by international normalized ratio (>1.3) and was not predictive of transfusion requirements or early or late mortality. CONCLUSION: Patients with elevated EtOH present with impaired clot formation as assayed by TEG, but this does not correlate with standard measures of coagulopathy or with outcome. Reliance on TEG for determining coagulopathy in intoxicated trauma patients may lead to a misperceived hypocoagulable state and inappropriate transfusion. TEG appears to be affected by EtOH in a previously unreported way, warranting further investigation. LEVEL OF EVIDENCE: Prognostic and epidemiologic study, level III.