2024 FSA Podium and Poster Abstracts
P055: PULMONARY HYPERTENSION AND CARDIAC ARREST FOLLOWING TOURNIQUET DEFLATION IN A SEPTIC KNEE SURGERY: A CASE REPORT
Karthik Sriganeshan1; Michael Fitzpatrick, MD2; Vijay Kurup3; Gerald Rosen, MD2; 1FIU Herbert Wertheim College of Medicine; 2Mt. Sinai Medical Center; 3Midwestern University Chicago College of Osteopathic Medicine
Intro: Pulmonary artery hypertension poses significant perioperative challenges due to its rare occurrence and potential for difficult to manage outcomes. Despite an increasing prevalence, the proper guidelines for managing pulmonary hypertension perioperatively remain scarce.
Case Presentation: We present a case of a 40-year-old male with an extensive past medical history which includes severe pulmonary hypertension, right ventricular dysfunction, and previous cardiac arrest post anesthesia induction presenting for a standard knee washout. To mitigate hemodynamic instability, a regional anesthesia approach compromising of both neuraxial blockade, and a peripheral nerve block was employed. Despite initial stability, tourniquet deflation led to resistant bradycardia and subsequent cardiac arrest. Management included ACLS protocols, ionotropic support, and pulmonary angiography ruling out embolism. Vigilant monitoring and interdisciplinary collaboration facilitated successful recovery.
Discussion and Conclusion: Cardiac arrest in our patient most likely resulted from ischemia reperfusion syndrome exacerbated by hypoxic pulmonary vasoconstriction after the tourniquet was released. This case highlights the increased perioperative risks associated with pulmonary hypertension and the importance of tailored anesthesia strategies and monitoring protocols. In addition to the complexity of management, this case shows the importance of a collaborative interdisciplinary approach to ensure favorable outcomes in high-risk patient groups.