Crush Syndrome Resulting from the Use of a Tourniquet: A case report / 대한마취과학회지

ABSTRACT

Although tourniquet application is a widely accepted adjuvant technique in the field of extremity surgery, its complication may be neglected. A 37-year-old healthy male underwent arthroscopic surgery for left posterior cruciate ligament reconstruction under a combination of spinal and epidural anesthesia. During the eleven hour operation, a tourniquet was applied four times in nine hours on the left thigh. The pressure reached 450 millimeters of mercury. Compartment syndrome developed with muscle ischemia and edema postoperatively. On the first day of the operation, a fasciotomy was performed to prevent the development of crush syndrome. However, bleeding due to vascular injury during the fasciotomy continued and crush syndrome including myoglobinemic renal failure, hyperkalemia, hypovolemic shock, and cardiac arrhythmia developed. On the second day, sudden cardiac arrest occurred during artery ligation. The patient was immediately resuscitated; he recovered, but his mental state was stuporous. Thereafter, the patient was cared intensively for eight days with fluid and electrolyte therapy, ventilatory care, hemodialysis, antibiotics for crush syndrome and renal failure, but the result was unsuccessful.