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Indian Journal of Clinical Anaesthesia


PROPHYLACTIC USE OF CORTICOSTEROIDS IN A SINGLE LONG BONE FRACTURE OF LOWER LIMB TO PREVENT FAT EMBOLISM SYNDROME – A CLINICAL EXPERIENCE


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Author Details: Prashanth N, Neeta PN, Amit RU, Shilpa K

Volume : 2

Issue : 1

Online ISSN : 2394-4994

Print ISSN : 2394-4781

Article First Page : 63

Article End Page : 69


Abstract

Background: Fat embolism syndrome is commonly associated with long bone fractures and the mortality associated with it is due to cerebral and pulmonary involvement. Recently experimental and clinical data have suggested that the benefit of corticosteroid therapy may be maximized if the treatment is given early as a prophylaxis for the development of the fat embolism syndrome in high risk patients. The aim of our study was to test the efficacy of single dose methyl prednisolone as prophylaxis to prevent Fat embolism syndrome in patients with single long bone fracture of lower limb.

Methods: We conducted a double blinded randomized control among 44 patients, who showed signs and symptoms of sub clinical fat embolism and fulfilled our inclusion and exclusion criteria over 2years period in a tertiary trauma care centre, Bangalore, Karnataka. These 44 patients were randomly selected and assigned 1 envelope and segregated to respective group. The nursing staffs who were educated about the division of groups administered the drug methyl prednisolone or normal saline accordingly. We were blinded to this allocation of groups and drug administration. The patients were followed up by us in the ICU and wards. At the end of study, the group allocation was disclosed. Among these patients were divided into Control Group A (21 patients), who were given placebo treatment with normal saline and Study Group B (23 patients), who were given a single dose of methyl prednisolone 30mg/kg over one hour.
Results: Among the 44 patients analyzed, 33.3% of group A and 8.7% of group B patients developed clinical Fat Embolism Syndrome (FES). The mean duration of ventilator support in group A (9.25 days) was higher than in the group B (7.33days). There was significant increase in the vital parameters like heart rate and respiratory rate as well as significant fall of Spo2, in control group than the study group postoperatively. There is no change in the PaCO2, systolic and diastolic blood pressure.
Conclusion: A Single prophylactic dose of Methyl Prednisolone 30 mg/kg significantly reduces the incidence of Fat Embolism Syndrome. Hence use of Methyl Prednisolone as a Prophylaxisfor Fat Embolism Syndrome in long bone fractures of lower limbs is beneficial.

Key words: Fat embolism syndrome, Methyl prednisolone, long bone fracture