If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. You will then receive an email that contains a secure link for resetting your password
If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password
Address correspondence to Sylvain Diop, Département d'Anesthésie et Réanimation, Hôpital Marie Lannelongue, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France.
Cardiothoracic Intensive Care Unit, Marie Lannelongue Hospital, Le Plessis Robinson, FranceDepartment of Anesthesiology, Marie Lannelongue Hospital, Le Plessis Robinson, France
Cardiothoracic Intensive Care Unit, Marie Lannelongue Hospital, Le Plessis Robinson, FranceUniversity Paris-Saclay, Kremlin-Bicêtre, FranceINSERM U999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Marie Lannelongue Hospital, Le Plessis-Robinson, France
We would like to share our experience regarding the use of regional anesthesia as an additional therapy in the intensive care unit for acute lower limb ischemia. A 40-year-old, 60-kg, 156-cm woman underwent lung transplant using right femoral venoarterial extracorporeal membrane oxygenation (ECMO) support for preoperative respiratory failure and right ventricle dysfunction related to pulmonary hypertension. Six days after surgery, the patient developed right lower limb ischemia downstream to the ECMO insertion site due to reperfusion cannula malfunction. The clinical improvement of cardiac and respiratory function allowed us to withdraw the ECMO support and perform a right superficial femoral artery embolectomy with a Fogarty catheter. Unfortunately, the right leg remained ischemic. Vascular ultrasound showed a major reduction of the right main tibial artery caliber, with an attenuated pulse-wave Doppler velocity (Fig 1, A and B). To improve perfusion, we performed a right popliteal sciatic nerve block with 15 mL of 0.475% ropivacaine under United States guidance. After the block, perfusion of the right leg was visibly improved. Vascular ultrasound showed a significant increase of the right main tibial artery caliber and pulse-wave Doppler velocity (Fig 1, C and D).
Fig 1Before popliteal sciatic nerve block: (A) Vascular ultrasound of the right tibial artery showing a narrow caliber of 22 mm. (B) Right tibial artery pulse-wave Doppler velocity showing an attenuated flow. Thirty minutes after popliteal sciatic nerve block: (C) Increased diameter of the right tibial artery measured at 67 mm. (D) Increase of the right tibial artery pulse-wave Doppler velocity.
This was the second time in our practice that we successfully used a peripheral nerve block in a context of limb ischemia. We suggest that regional anesthesia could be a useful intervention after the primary cause of ischemia is treated (in this patient, after withdrawal of the ECMO cannula and arterial embolectomy).
Conflict of Interest
None.
Reference
Bonicolini E
Martucci G
Simons J
et al.
Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation: a narrative review of incidence, prevention, monitoring, and treatment.
00714-5&id=gr1.jpg){kind=link}