Obesity is a worldwide epidemic associated to comorbidities and increased mortality. Because it is chronic and recurrent and has little response to clinical measures, surgical treatment (bariatric surgery) is a therapeutic option frequently used. Different surgical complications have been associated with this type of procedure, but there is little knowledge about neuromuscular complications. Among the latter, rhabdomyolysis (RML), described a few years ago, has not been well characterized to date. We have studied 22 consecutive patients who underwent surgical treatment with open Roux-en-Y gastric bypass (RYGBP) for morbid obesity in a university hospital. A database was created including the following information of each patient: gender, age, body mass index (BMI), comorbidities, surgical time, pre- and postoperative creatine phosphokinase (CPK) dosages, and neuromuscular symptoms after surgery. The main outcome measure was the frequency of RML using CPK dosage after 24 h of surgery. RML was diagnosed as an increase of more than five times the superior limit of normal range of CPK. Fourteen women and eight men were evaluated, with median age of 39.9 ± 11.2 years, median BMI of 52.4 ± 8.0 kg/m2 and mean surgical time of 253.2 ± 51.9 min. The mean value of postoperative CPK was 7,467.7 ± 12,177.1 IU/L, being greater than 5,000 IU/L in 40.9% of the patients. RML was diagnosed in 17 (77.3%) patients. No patient had renal failure caused by RML, but there was one death (4.5%) related to abdominal infectious complications. Clinical neuromuscular symptoms occurred in 45% of patients, and muscular pain was the most common one, especially in gluteus region. Comparative analyzes between patients without and with RML diagnosis showed that longer surgical time (p = 0.005), and occurrence of neuromuscular symptoms (p = 0.04) were more common in the latter. The results of this study are similar to few other investigations and confirm that RML in open bariatric surgery with RYGBP (Capella) is a common complication. A longer surgical time can be involved in RML pathogenesis, and muscular pain is suggestive of RML occurrence.

Rhabdomyolysis after bariatric surgery by Roux-en-Y gastric bypass: a prospective study.

Study Design. The case of a complication sustained by an obese patient undergoing a lumbar spine fusion is reported. Objectives. To minimize further complications by reporting on this case complicated by rhabdomyolysis in a lumbar fusion, and to include a review of the literature. Summary of Background Data. Rhabdomyolysis has been described as a clinical syndrome initially characterized by darker urine, muscle pain, and weakness from prolonged muscle compression, as in intoxicated patients or after a seizure. Rhabdomyolysis and myoglobinuria have also been reported in the prolonged positions of some surgical procedures. Methods. A 40-year-old man developed progressively incapacitating lumbar pain above a previous fusion from L4 to S1, with a severe decline in his functional capacities and a large weight gain. Revision surgery removing the previous instrumentation and performing an instrumented fusion from L2 to L4 was complicated by rhabdomyolysis. Results. After an unremarkable surgery, this patient was hemodynamically unstable when transferred from the operating table to the supine position and required aggressive treatment of severe rhabdomyolysis, which has not previously been reported in this setting. Conclusion. Patients undergoing lumbar spine surgery require decompression of the abdomen, and in this case, a Jackson table was used. Unfortunately, his abdominal girth, even on a Jackson table, was not fully decompressed and resulted in this complication. Further consideration should be given to modifications of positioning for morbidly obese patients.

Rhabdomyolysis in lumbar spine surgery: a case report.

Background: Rhabdomyolysis (RML) is a recently recognized complication of bariatric operations, but it is not known whether creatine kinase (CK) levels along with clinical markers are able to define the course and outcome. Methods: Bariatric patients (n=324) were reviewed retrospectively. Substantially elevated plasma CK after operation was identified in 4.9% (16/324). The affected population was divided into Group I (n=11, 68.8%) with CK 1050-8000 IU/L and no conspicuous muscle pain, weakness or swelling, and Group II (n=5, 31.2%) displaying CK >8000 IU/L and severe pain and dysfunction. The main outcome measures were CK concentration, frequency of renal failure, need for hemodialysis and mortality. Results: Group I subjects compared to Group II were younger (37.7 ± 10.9 vs 44.0 ± 5.5 years, P<0.05) and predominantly females (72.7% vs 40.0%, P<0.05). Peak CK values were definitely lower (2811 ± 952 vs 28136 ± 19000 IU/L, P<0.001), and none progressed to renal failure (0% vs 40.0%, P<0.05). No difference was detected regarding preoperative BMI (50.8 ± 8.1 vs 54.6 ± 7.0 kg/m 2 , NS), duration of operation (5.3 ± 1.6 vs 5.6 ± 2.1 hours, NS) or types of anesthetic drugs (basically fentanyl, nitrogen oxide and halothane/isoflurane). Conclusions: 1) Demographic features, nominally gender and age, were different between the two degrees of RML; 2) Renal failure and hemodialysis were a danger only in patients with massive CK elevation and muscle pain; 3) Moderate CK increase was very well tolerated and rarely entailed major clinical symptoms; 4) Early diagnosis, fluid replenishment and general supportive therapy probably contributed to avert mortality.

Rhabdomyolysis after gastric bypass: severity and outcome patterns.

Development of malignant hyperthermia post-cardiopulmonary bypass during surgery for mitral valve replacement.

Development of malignant hyperthermia during cardiopulmonary bypass.

There are many causes of rhabdomyolysis, including crush injury, heat stroke, muscle ischaemia, necrotizing myositis following acute viral infections such as glandular fever and influenza, and as a result of hypokalaemic myopathy induced by chronic diuretic ingestion'. Rhabdomyolysis may also be precipitated by anaesthesia in disorders such as malignant hyperpyrexia, the muscular dystrophies, and neuroleptic malignant syndrome. We describe the development of massive rhabdomyolysis after elective coronary artery bypass surgery and discuss the possible diagnoses.

Massive rhabdomyolysis following cardiopulmonary bypass.

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Massive rhabdomyolysis following cardiopulmonary bypass.