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Intraoperative lower extremity compartment pressures in lithotomy-positioned patients
J Chase1, F Harford, M S Pinzur
1Department of Orthopedic Surgery and Rehabilitation, Loyola University Medical Center, Loyola University Stritch School of Medicine, Maywood, Illinois 60153, USA.
Diseases of the Colon and Rectum
|May 29, 2000
Summary
Prolonged lithotomy positioning during surgery can increase leg compartment pressures, potentially leading to compartment syndrome. Pressures normalize when limbs are returned to a supine position.
Area of Science:
- Surgical positioning
- Physiology
- Orthopedics
Background:
- Surgical positioning can affect patient physiology.
- The lithotomy position is common in colorectal surgery.
- Potential risks of prolonged positioning are not fully understood.
Purpose of the Study:
- To measure anterior leg compartment pressures in patients undergoing prolonged lithotomy positioning.
- To assess the impact of lithotomy and Trendelenburg positioning on leg compartment pressures.
Main Methods:
- Anterior leg compartment pressures were measured using a slit catheter.
- Eight patients (16 limbs) were studied during colorectal intra-abdominal surgery.
- Measurements were taken during prolonged lithotomy and Trendelenburg positioning.
Main Results:
- Compartment pressures initially elevated and gradually increased over time.
- Pressures reached 30 mmHg at an average of five hours.
- Trendelenburg positioning consistently increased pressures; all pressures normalized post-positioning.
Conclusions:
- Prolonged lithotomy positioning increases leg anterior compartment pressures.
- Trendelenburg positioning exacerbates this pressure increase.
- Positioning may initiate compartment syndrome after approximately five hours.