Fatal intra-operative pulmonary embolism following application of an Esmarch bandage.

The objective of this paper is to raise the awareness of a possible fatal complication during operations in the lower limbs, when an Esmarch bandage is used for exsanguination of the affected limb during the operation. After reviewing the literature, four cases of fatal massive pulmonary embolism have been identified after Esmarch bandage application in trauma patients [Acta Anaesthesiol Belg 50(2) (1999) 95, Reg. Anaesth 6 (1983) 83, Anesthesiology 58 (1983) 373, Anaesthesia 25(3) (1970) 445] but there is no any reference to an elective case. The authors would like to report two cases of fatal embolism after Esmarch bandage application for both elective surgery (total knee replacement) and trauma (trimalleolar fracture). Both patients had received regional anaesthesia. After comparing the data from our cases and the literature, it is recommended that the Esmarch bandage should not be used in trauma, especially when there has been a delay in time for surgery. In elective cases of the lower limbs, preoperative cardiovascular evaluation and the exclusion of other factors predisposing to DVT are necessary, especially for patients more than 50 years old.