Clinical Features of Rhabdomyolysis After Open and Laparoscopic Roux-en-Y Gastric Bypass

Ettinger, João Eduardo Marques Tavares de Menezes; Souza, Carlos Alfredo Marcílio de; Ázaro, Euler; Mello, Carlos Augusto Bastos; Santos-Filho, Paulo V.; Orrico, Juliana; Santana, R.; Amaral, Paulo C G; Fahel, Edvaldo; Batista, Paulo Benígno Pena

doi:10.1007/s11695-007-9257-1

Cited by 25 publications

(19 citation statements)

References 13 publications

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“…This result is consistent with Ettinger et.al [11] who described an incidence of 7% and in contrast with Mognol et al [12] and Lagandré et al [3], who reported an incidence of 22.7% and 26% respectively. A prolonged operative time is an important risk factor for the development of post-operative RML [3,11,12,14], indeed in our study, almost all the patients who developed RML had operative time ≥ 4 hours (5 out of 6, 83%). High BMI and arterial hypertension are potential risk factors for the development of RML.…”

Section: Discussionsupporting

confidence: 92%

“…RML has been recognized as a complication of bariatric surgery. Recently, several retrospective and prospective studies described such complication in obese patients undergoing bariatric or general surgery [3,[10][11][12]. Probably RML following bariatric surgery is caused by a muscle pressure occurring during surgery which results in the creation of a compartmental syndrome [12].…”

Section: Introductionmentioning

confidence: 99%

“…Probably RML following bariatric surgery is caused by a muscle pressure occurring during surgery which results in the creation of a compartmental syndrome [12]. The high BMI, the duration of operations, the lithotomy position, the ASA (American Society of Anesthesiologists) physical status III-IV, the presence of comorbidities such as hepatic steatosis, hypertension and diabetes mellitus [3,[11][12][13][14], are risk factors associated with the development of RML. The incidence of post-operative RML has been estimated from a minimum of 1.4% [15] to a maximum of 75% [10].…”

Section: Introductionmentioning

confidence: 99%

“…For this reason, during all phases of bariatric surgery it is essential to actualize some precautions which can help to preserve muscle integrity: padding of pressure areas, use of pneumatic beds during operations, optimal position of the surgical table, reduction of surgical time, change of patient position intra-and postoperatively and encouraging patients to an early ambulation [14]. Furthermore, it is possible to early diagnose RML after surgery by monitoring CPK and myoglobin levels in order to prevent and promptly treat its complications (hypovolemia, acidosis, hyperkalemia, AKI, DIC and hepatic dysfunction) [11,14].…”

Section: Introductionmentioning

confidence: 99%

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Rhabdomyolysis Following Bariatric Surgery: a Retrospective Analysis

Forfori¹,

Sayburn²,

Taddei³

et al. 2013

TOOBESJ

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Abstract:Background: Rhabdomyolysis (RML) indicates a skeletal muscle necrosis which results in an emission of intracellular contents from myocytes into the circulatory system. It has been recognized to be a complication of bariatric surgery. A high BMI and a prolonged operative time are the main risk factors associated to the development of RML. The aim of this study is to define the incidence and the main features of RML in a cohort of obese patients undergoing bariatric surgery.Materials and Methods: a retrospective observational analysis was carried out on 100 patients undergone bariatric surgery. The bariatric operations were open or laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (SG); they were performed at the university hospital Nuovo S. Chiara in 2011.Results: 6 of 100 patients enrolled developed RML. Three of these also showed acute kidney injury due to RML (50%). A significant correlation between post-operative increased creatine phosphokinase (CPK) levels and BMI was found (r=0.369; r 2 =0,137; p=0.005) as well as a significant correlation between the increased levels of creatine phosphokinase, myoglobin and operative time (increased operative time -highest CPK: r=0.550; r 2 =0.302; p<0.0001; increased operative time -highest myoglobin: r=0.553; r 2 =0.305; p<0.0001). Moreover, hypertension and prolonged operative time were found to be variables associated with RML in bivariate analysis. Conclusions:The incidence of RML following bariatric surgery was 6%. Since rhabdomyolysis is the most important complication of bariatric surgery, appropriate precautions should be taken during surgery. Post-operative monitoring of CPK and myoglobin levels is essential for an early diagnosis of RML.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Rhabdomyolysis Following Bariatric Surgery: a Retrospective Analysis

Forfori¹,

Sayburn²,

Taddei³

et al. 2013

TOOBESJ

View full text Add to dashboard Cite

show abstract

“…13,14 In some cases, surgical time may be reduced by planning a two-staged procedure. In cases where RML is suspected, high urine output should be promoted with the administration of intravenous fluids and diuretics before, during, and after surgery.…”

Section: Discussionmentioning

confidence: 99%

Case report: Rhabdomyolysis in morbidly obese patients: anesthetic considerations

Ankichetty

Angle

Margarido

et al. 2012

Can J Anesth/J Can Anesth

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Purpose We report the presentation and management of rhabdomyolysis involving shoulder girdle and upper arm muscles in a morbidly obese patient after prolonged laparoscopic surgery. Clinical features A 41-yr-old morbidly obese woman presented for laparoscopic abdominal hysterectomy. She had hypertension and type II diabetes which were controlled on regular medications. She also had obstructive sleep apnea. Her clinical examination and investigations revealed no abnormality except morbid obesity (body mass index 54 kgÁm -2 ) and left ventricular hypertrophy on transthoracic echocardiogram. Standard general anesthesia was administered under baseline non-invasive monitors. Succinylcholine was used to secure the airway during anesthetic induction. Surgery was performed with the patient positioned with a 15°head-down tilt, and it took six hours to complete the procedure as technical difficulty was encountered due to her body habitus. Her trachea was extubated and she was transferred to the postanesthetic care unit (PACU) without incident.In the PACU, the patient complained of severe bilateral arm pain and weakness an hour after surgery. On physical examination, she exhibited limited movement of her arms against gravity while complaining of tenderness in her shoulder girdle muscles and both arms. Clinical suspicion of rhabdomyolysis based on her signs and symptoms was confirmed by an elevated serum creatinine kinase (CK) of 18,392 IUÁL -1 and serum potassium of 5.3 mmolÁL -1 . Intravenous crystalloids and mannitol were administered for 24 hr for renal protection, and her clinical symptoms and serum CK levels improved over seven days. The patient was discharged to home on the tenth postoperative day, and she continued to improve over the three-month followup period. Conclusions Morbidly obese patients who undergo prolonged surgery are at risk for rhabdomyolysis, and early diagnosis and therapy are required to prevent severe complications. RésuméObjectif Nous rapportons la pre´sentation et la prise en charge d'un cas de rhabdomyolyse touchant la ceinture scapulaire et les muscles des bras supe´rieurs d'une patiente obe`se morbide apre`s une chirurgie laparoscopique prolonge´e. É léments cliniques Une femme obe`se morbide de 41 ans s'est pre´sente´e pour une hyste´rectomie abdominale par laparoscopie. Elle souffrait d'hypertension et de diabe`te de type II, lesquels e´taient contrôle´s par un traitement me´dicamenteux re´gulier. Elle souffrait e´galement d'apne´e obstructive du sommeil. L'examen clinique et les analyses n'ont re´ve´le´aucune anomalie hormis une obe´site´morbide (indice de masse corporelle 54 kgÁm -2

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