A case of rhabdomyolysis associated with use of a pneumatic tourniquet during arthroscopic knee surgery

Abstract

The common causes of rhabdomyolysis include trauma, hypoxia, drugs, toxins, infections and hyperthermia. Operative insults, including direct trauma and ischemia, have the potential to cause the development of rhabdomyolysis. Pneumatic tourniquets used during arthroscopic knee surgery to prevent blood loss have led to many complications such as nerve paralysis and vascular injuries. Rhabdomyolysis can also be caused by prolonged pneumatic tourniquet application without a midapplication release, and also from an increased application pressure, but the actual incidence of this is low. In order to prevent rhabdomyolysis, the clinicians must be aware of such risks and follow strict guidelines for the application time, the midapplication release and also the inflation pressure. Vigorous hydration and postoperative patient surveillance are helpful to prevent rhabdomyolysis. We have recently experienced a case of rhabdomyolysis after the arthroscopic knee surgery, and the rhabdomyolysis could have been associated with the use of a pneumatic tourniquet.

Keywords: Kidney failure, acute; Rhabdomyolysis; Tourniquets.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1

Abdominal ultrasonographic findings. Both kidneys were enlarged (the right kidney 12.6 cm and the left kidney 13.0 cm in length), and their echogenecity increased.

Figure 2

Technetium-99m HDP whole body bone scan. Focal soft tissue uptakes are noted at the right proximal femur area and left thigh area, which is consistent with rhabdomyolysis. HDP, hydroxymethylene diphosphonate.

Figure 3

The changes of the serum creatinine level during the hospitalization.