Abdominal compartment syndrome successfully treated with neuromuscular blockade

Kris T Chiles, Colin M Feeney, Kris T Chiles, Colin M Feeney

Abstract

A 48 year old male admitted to the intensive care unit after a cardiac arrest complicated by a stroke intra-operatively during automatic implantable cardioverter defibrillator placement. He post-operatively developed a rigid abdomen, elevated peak and plateau pressures, hypoxia and renal insufficiency. He was diagnosed with abdominal compartment syndrome with an intra-abdominal compartment pressure of 40mmHg. The patient was administered 10 mg of intravenous cisatracuriumbesylate in preparation for bedside surgical abdominal decompression. Cisatracurium eliminated the patients need for surgical intervention by reducing his abdominal compartment pressures to normal and improving his hypoxia and renal function. This case illustrates that neuromuscular blockade should be attempted in patients with abdominal compartment syndrome prior to surgical intervention.

Keywords: Abdominal compartment syndrome; intra-abdominal hypertension; medical management of abdominal compartment syndrome; neuromuscular blockade.

Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
Computed tomography of the abdomen and pelvis showing no dilated loops of bowel, ileus, free air, abscess or obstruction

References

    1. Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome.I. Definitions. Intensive Care Med. 2006;32:1722–32.
    1. Ivatury RR, Porter JM, Simon RJ, Islam S, John R, Stahl WM. Intra-abdominal hypertension after life-threatening penetrating abdominal trauma: Prophylaxis, incidence, and clinical relevance to gastric mucosal pH and abdominal compartment syndrome. J Trauma. 1998;44:1016–21.
    1. Malbrain ML, Chiumello D, Pelosi P, Bihari D, Innes R, Ranieri VM, et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: A multiple-center epidemiological study. Crit Care Med. 2005;33:315–22.
    1. Ivatury R, Diebel L. Abdominal Compartment Syndrome. In: Ivatury R, Cheatham M, Malbrain M, Sugrue M, editors. Abdominal Compartment Syndrome. Georgetown TX: Landes Bioscience; 2006. pp. 129–137.
    1. Balogh Z, McKinley BA, Holcomb JB, Miller CC, Cocanour CS, Kozar RA, et al. Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. J Trauma. 2003;54:848–59.
    1. Cheatham ML, Malbrain ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome.II. Recommendations. Intensive Care Med. 2007;33:951–62.
    1. Macalino JU, Goldman RK, Mayberry JC. Medical management of abdominal compartment syndrome: Case report and a caution. Asian J Surg. 2002;25:244–6.
    1. De laet I, Hoste E, Verholen E, De Waele JJ. The effect of neuromuscular blockers in patients with intra-abdominal hypertension. Intensive Care Med. 2007;33:1811–4.
    1. De Waele JJ, Benoit D, Hoste E, Colardyn F. A role for muscle relaxation in patients with abdominal compartment syndrome. Intensive Care Med. 2003;29:332.
    1. Walker J, Criddle LM. Pathophysiology and management of abdominal compartment syndrome. Am J Crit Care. 2003;12:367–71.
    1. Cakmak M, Caglayan F, Somuncu S, Leventoglu A, Ulusoy S, Akman H, et al. Effect of paralysis of the abdominal wall muscles by botulinum a toxin to intrabdominal pressure: An experimental study. J Pediatr Surg. 2006;41:821–5.
    1. Suleiman S, Johnston DE. The abdominal wall: An overlooked source of pain. Am Fam Physician. 2001;64:431–9.
    1. Peleg R, Shvartzman P. Case report: Cutaneous nerve entrapment.Abdominal wall pain in an elderly patient. Can Fam Physician. 2001;47:788–9.
    1. Srinivasan R, Greenbaum DS. Chronic abdominal wall pain: A frequently overlooked problem. Practical approach to diagnosis and management. Am J Gastroenterol. 2002;97:824–30.
    1. Dafotakis M, Sparing R, Becker S, Fink GR. Epilepsia partialis continua of the abdominal muscles with transient MRI abnormalities. Neurology. 2006;66:1099.
    1. Parr MJ, Olvera CI. Medical management of abdominal compartment syndrome. In: Ivatury RR, Cheatham ML, Malbrain ML, Sugrue M, editors. Abdominal compartment syndrome. Georgetown, TX: Landes Bioscience; 2006. pp. 232–9.
    1. Mertens zur Borg IR, Verbrugge SJ. Anesthetic considerations in abdominal compartment syndrome. In: Ivatury RR, Cheatham ML, Malbrain MLNG, Sugrue M, editors. Abdominal compartment syndrome. Georgetown, TX: Landes Bioscience; 2006. pp. 254–65.
    1. Mayberry JC. Prevention of abdominal compartment syndrome. In: Ivatury RR, Cheatham ML, Malbrain ML, Sugrue M, editors. Abdominal compartment syndrome. Georgetown, TX: LandesBioscience; 2006. pp. 223–31.

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