Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2022; 10(4): 1349-1356
Published online Feb 6, 2022. doi: 10.12998/wjcc.v10.i4.1349
Fatal rhabdomyolysis and disseminated intravascular coagulation after total knee arthroplasty under spinal anesthesia: A case report
Dae Hun Yun, Eun Ha Suk, Wan Ju, Eun Hyoung Seo, Hyun Kang
Dae Hun Yun, Eun Ha Suk, Wan Ju, Eun Hyoung Seo, Hyun Kang, Department of Anesthesiology and Pain Medicine, Kwangju Christian Hospital, Gwangju 61661, South Korea
Author contributions: Yun DH, Kang H, and Seo EH cared for the patient, conceived and designed the case report, and wrote the manuscript; Yun DH, Suk EH, and Ju W edited the manuscript; Suk EH and Ju W supervised the work; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Eun Ha Suk, PhD, Department of Anesthesiology and Pain Medicine, Kwangju Christian Hospital, 37 Yangnim-ro, Nam-gu, Gwangju 61661, South Korea. d013084@naver.com
Received: August 12, 2021
Peer-review started: August 12, 2021
First decision: October 20, 2021
Revised: October 22, 2021
Accepted: December 23, 2021
Article in press: December 23, 2021
Published online: February 6, 2022
Processing time: 165 Days and 2.4 Hours
Abstract
BACKGROUND

Rhabdomyolysis develops as a result of skeletal muscle cell collapse from leakage of the intracellular contents into circulation. In severe cases, it can be associated with acute kidney injury and disseminated intravascular coagulation, leading to life threatening outcomes. Rhabdomyolysis can occur in the perioperative period from various etiologies but is rarely induced by tourniquet use during orthopedic surgery.

CASE SUMMARY

A 77-year-old male underwent right total knee arthroplasty using a tourniquet under spinal anesthesia. About 24 h after surgery, he was found in a drowsy mental state and manifested features of severe rhabdomyolysis, including fever, hypotension, oliguria, high creatine kinase, myoglobinuria, and disseminated intravascular coagulation. Despite supportive care, cardiac arrest developed abruptly, and the patient was not able to be resuscitated.

CONCLUSION

Severe rhabdomyolysis and disseminated intravascular coagulation can develop from surgical tourniquet, requiring prompt, aggressive treatments to save the patient.

Keywords: Rhabdomyolysis; Total knee arthroplasty; Tourniquet; Disseminated intravascular coagulation; Case report

Core Tip: Although total knee arthroplasty under spinal anesthesia using a tourniquet is widely performed in elderly patients, physicians should be aware of the possibility of tourniquet-induced rhabdomyolysis after surgery. Careful use of a tourniquet and maintaining an adequate hemodynamic state in the perioperative period is important to prevent rhabdomyolysis. Nonspecific symptoms, such as altered mental state, can obscure a prompt diagnosis and delay early treatment. Regular monitoring and careful evaluations are necessary to detect rhabdomyolysis early, and aggressive therapies, including early vigorous hydration, are required.