Diastolic blood pressure in patients with tibia fractures under anaesthesia: implications for the diagnosis of compartment syndrome.
OBJECTIVE
In the treatment of tibia fractures, is the intraoperative diastolic blood pressure (DBP) less than pre- and postoperative DBP, and how does this relate to the diagnosis of compartment syndrome using DeltaP (diastolic blood pressure [DBP] - intracompartmental pressure)?


METHODS
This was a prospective cohort study in a level 1 trauma center, with a consecutive series of 242 patients with a tibia fracture.


METHODS
Intramedullary nail fixation of tibia fractures under general anesthesia.


METHODS
Patient demographics, type and location of fracture, injury severity score, and blood pressures preoperatively, intraoperatively, and postoperatively.


RESULTS
There were 187 male and 55 female patients, whose ages ranged from 16 to 87 years (average, 39 years). There were 123 open and 119 closed tibia fractures. The average injury severity score was 14.7 (range: 9-41). Anesthetized patients had a significant decrease in their DBP and systolic blood pressure (SBP) compared with their preoperative, postanesthesia care unit and postoperative floor measurements. The mean DBP in the operating room was 18 +/- 13 mm Hg lower than the preoperative measurement (P < 0.05), whereas the difference in the preoperative and postoperative mean DBP was only 2 +/- 13 mm Hg.


CONCLUSIONS
There is a predictable response of DBP in patients with tibia fractures treated with intramedullary (IM) nailing under general anesthesia. The preoperative DBP is a good indicator of the postoperative DBP, and the intraoperative DBP is significantly lower (average 18 mm Hg; P < 0.05). The surgeon should recognize that intraoperative DeltaP may be lower than DeltaP once the patient is awakened in deciding whether to perform a fasciotomy or awaken the patient and perform serial examinations and or compartment pressure measurements. Intraoperative DeltaP may be spuriously low compared with that after the patient is awakened.
Kakar
Sanjeev
S
Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA 02118, USA.
Firoozabadi
Reza
R
McKean
Jason
J
Tornetta
Paul
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination; D003161:Compartment Syndromes / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D003971:Diastole; D005260:Female; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011446:Prospective Studies; D013978:Tibial Fractures / Q000150:complications* / Q000601:surgery