Anesthesia Considerations 

Abdominal Compartment Syndrome (ACS) 

 

 

Background 

 

• Definition: sustained intraabdominal pressure >20 mmHg that is associated with new organ dysfunction

• Patients with an intraabdominal pressure <10 mmHg generally do not have ACS, while patients with an intraabdominal pressure >25 mmHg usually have ACS

• Higher systemic blood pressure will be needed to perfuse abdominal organs, keep abdominal perfusion pressure (APP) (systemic blood pressure - intraabdominal pressure) >60mmHg

• Etiology: 

  • Primary: due to injury or disease in the abdominopelvic region (e.g., pancreatitis, abdominal trauma)

    • Intervention (surgical or radiologic) of the primary condition is often needed 

  • Secondary: does not originate in the abdomen or pelvis (e.g., fluid resuscitation, sepsis, burns)

 

 

Considerations

 

• Critically ill patient with high mortality & morbidity

• Multisystemic dysfunction:

  • Airway: ↑ risk of aspiration

  • CVS: ↓ cardiac output (CO) from ↓ preload & ↑ SVR

  • Resp:  Hypoxia secondary to restrictive ventilation

  • Renal:  Potential for AKI 

  • GI:  Hepatic dysfunction (altered pharmokinetics)

• Need to maintain APP > 60 mmHg

• Consequences of decompression:

  • Sudden ↓ in cardiac output & SVR

  • Reperfusion: risk of systemic acidosis & hyperkalemia

  • Possible fatal arrhythmia & arrest

  • Sudden change in respiratory compliance (avoid overventilation)

 

 

Goals/Conflicts

 

• Early identification of ACS

• Maintain APP >60mmHg

• Avoid bradycardia (preload is compromised & CO may be heart rate dependent)

• Maintain high preload particularly once decompressed

• Be prepared for sudden arrhythmias associated with hyperkalemia & acidosis after decompression occurs