Ozkan Onal, M. Emin Zora, Omur Ilban, Emine Aslanlar and Jale Bengi Celik

ABSTRACT

Fat embolism syndrome is a serious and potentially fatal complication that can occur in long bone fractures and orthopedic procedures. It is characterized by petechial rash, hypoxia, respiratory failure, focal or global neurological dysfunction and thrombocytopenia. In this case report, successfull anesthesia management in a patient with cerebral fat embolism after a traffic accident is discussed. In a 34 year old male patient without any known disease, bilateral lung contusion and bilateral femur fracture were detected after a traffic accident in a vehicle. 24 hours after admission, blurred consciousness and predisposisiton to sleep developed. There were widesperead petechia on the skin and respiratory difficulty developed. Then the patient was intubated and transferred to anesthesia intensive care unit. Fluid replacement was carried out. Patient was hypotensive and dopamine infusion was initiated. In brain MR, infarcts were seen in the parenchyme tissue, which were found to be consistent with fat embolism. After the stabilization of general condition, the patient was operated by orthopedics department for femur fractures. During operation, hypotension was especially avoided. Oxygen support was increased to 100% from time to time. Intraoperatively, there was no impairment in urine output and vital values. Post-traumatic fat embolism syndrome is one that leads to pulmonary and neurological dysfunction and petechia and pyrexia. It may occur in the fractures of large bones. Treatment is supportive and non specific. The most important measure that can be taken in these patients is early resuscitation, controlling stress responses and avodiding hypovolemia. Fat embolism syndrome occurs within first 72 hours of trauma. Long term fractures of these patients should be corrected by operation within a short time. For anethesists, hypovolemia, respiratory problems and mechanic ventilations are points that should be taken into account in these patients. Keywords: Anaesthesia, fat embolism