Autonomic Cascade Secondary to Acute Urinary Retention in a Patient undergoing Open Reduction of Forearm Fracture under General Anaesthesia: A Case Report

Abstract

Acute Urinary Retention (UR) is a common perioperative complication with incidences between 5-70%. Orthopaedic patients tend to have this complication at a comparatively higher incidence rate (8-55%) than any other surgeries. Acute UR is multifactorial and can occur irrespective of any pre-existing urological condition. Acute distension due to UR is sometimes associated with comparatively rare manifestations of cardiovascular morbidity in the form of rhythm disturbances and massive haemodynamic alterations. In this case, a 62-year-old, 50 kg female with no co-morbidities was scheduled for open reduction of a fractured right forearm under General Anaesthesia (GA) in the supine position. Towards the end of the surgery, there was an abrupt change in the patient’s haemodynamics, starting from hypertension with tachycardia to hypotension with tachycardia followed by extreme bradycardia. A quick inspection revealed bladder overdistension due to the blockade of the urinary catheter. After saline flushing and decompression of the bladder, the haemodynamics returned to normal within five minutes. Acute bladder overdistension is a relatively benign complication that may prove fatal if not addressed promptly.

Keywords

• bradycardia
• cardiac arrhythmia
• intraoperative complication
• open fracture reduction
• orthopaedic procedures
• urinary catheterisation