Is rhabdomyolysis an anaesthetic complication in patients undergoing robot-assisted radical prostatectomy?
Background: In patients undergoing robot-assisted radical prostatectomy (RARP), pneumoperitoneum, intraoperative fluid restriction and prolonged Trendelenburg position may cause rhabdomyolysis (RM) due to hypoperfusion in gluteal muscles and lower extremities. In this study, it was aimed to assess e...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2017-01-01
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| Series: | Journal of Minimal Access Surgery |
| Subjects: | |
| Online Access: | http://www.journalofmas.com/article.asp?issn=0972-9941;year=2017;volume=13;issue=1;spage=29;epage=36;aulast=Karaoren |
| _version_ | 1811288560773365760 |
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| author | Gulsah Karaoren Nurten Bakan Eyüp Veli Kucuk Eyup Gumus |
| author_facet | Gulsah Karaoren Nurten Bakan Eyüp Veli Kucuk Eyup Gumus |
| author_sort | Gulsah Karaoren |
| collection | DOAJ |
| description | Background: In patients undergoing robot-assisted radical prostatectomy (RARP), pneumoperitoneum, intraoperative fluid restriction and prolonged Trendelenburg position may cause rhabdomyolysis (RM) due to hypoperfusion in gluteal muscles and lower extremities. In this study, it was aimed to assess effects of body mass index (BMI), comorbidities, intra-operative positioning, fluid restriction and length of surgery on the development of RM in RARP patients during the perioperative period. Subjects and Methods: The study included 52 American Society of Anesthesiologists I–II patients aged 50–80 years with BMI >25 kg/m2, who underwent RARP. Fluid therapy with normal saline (1 ml/kg/h) and 6% hydroxyethyl starch 200/05 (1 ml/kg/h) was given during the surgery. Charlson comorbidity index (CCI), operation time (OT) and Trendelenburg time (TT) were recorded. Blood samples for creatine phosphokinase (CPK), blood urea nitrogen, creatinine (Cr), aspartate aminotransferase (AST), alanine transferase (ALT), lactate dehydrogenase (LDH), creatinine kinase-MB, cardiac troponin I and arterial blood gases were drawn at baseline and on 6, 12, 24 and 48 h. RM was defined by serum CPK level exceeding 5000 IU/L. Results: Seven patients met predefined criteria for RM. There were positive correlations among serum CPK and Cr, AST, ALT and LDH levels. However, there was no significant difference in BMI, OT and TT between patients with or without RM (P > 0.05). CCI scores were higher in patients with RM than those without (3.00 ± 0.58 vs. 2.07 ± 0.62; P< 0.01). No renal impairment was detected among patients with RM at the post-operative period. Conclusions: It was found that comorbid conditions are more important in the development of RM during RARP rather than BMI, OT or TT. Patients with higher comorbidity are at risk for RM development and that this should be kept in mind at follow-up and when informing patients. |
| first_indexed | 2024-04-13T03:39:43Z |
| format | Article |
| id | doaj.art-c684e2d713ed408eb7f7d1dd025b9341 |
| institution | Directory Open Access Journal |
| issn | 0972-9941 1998-3921 |
| language | English |
| last_indexed | 2024-04-13T03:39:43Z |
| publishDate | 2017-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Minimal Access Surgery |
| spelling | doaj.art-c684e2d713ed408eb7f7d1dd025b93412022-12-22T03:04:12ZengWolters Kluwer Medknow PublicationsJournal of Minimal Access Surgery0972-99411998-39212017-01-01131293610.4103/0972-9941.181291Is rhabdomyolysis an anaesthetic complication in patients undergoing robot-assisted radical prostatectomy?Gulsah KaraorenNurten BakanEyüp Veli KucukEyup GumusBackground: In patients undergoing robot-assisted radical prostatectomy (RARP), pneumoperitoneum, intraoperative fluid restriction and prolonged Trendelenburg position may cause rhabdomyolysis (RM) due to hypoperfusion in gluteal muscles and lower extremities. In this study, it was aimed to assess effects of body mass index (BMI), comorbidities, intra-operative positioning, fluid restriction and length of surgery on the development of RM in RARP patients during the perioperative period. Subjects and Methods: The study included 52 American Society of Anesthesiologists I–II patients aged 50–80 years with BMI >25 kg/m2, who underwent RARP. Fluid therapy with normal saline (1 ml/kg/h) and 6% hydroxyethyl starch 200/05 (1 ml/kg/h) was given during the surgery. Charlson comorbidity index (CCI), operation time (OT) and Trendelenburg time (TT) were recorded. Blood samples for creatine phosphokinase (CPK), blood urea nitrogen, creatinine (Cr), aspartate aminotransferase (AST), alanine transferase (ALT), lactate dehydrogenase (LDH), creatinine kinase-MB, cardiac troponin I and arterial blood gases were drawn at baseline and on 6, 12, 24 and 48 h. RM was defined by serum CPK level exceeding 5000 IU/L. Results: Seven patients met predefined criteria for RM. There were positive correlations among serum CPK and Cr, AST, ALT and LDH levels. However, there was no significant difference in BMI, OT and TT between patients with or without RM (P > 0.05). CCI scores were higher in patients with RM than those without (3.00 ± 0.58 vs. 2.07 ± 0.62; P< 0.01). No renal impairment was detected among patients with RM at the post-operative period. Conclusions: It was found that comorbid conditions are more important in the development of RM during RARP rather than BMI, OT or TT. Patients with higher comorbidity are at risk for RM development and that this should be kept in mind at follow-up and when informing patients.http://www.journalofmas.com/article.asp?issn=0972-9941;year=2017;volume=13;issue=1;spage=29;epage=36;aulast=KaraorenAcute renal failurecomorbidityminimally invasive surgeryprostatectomyrhabdomyolysisTrendelenburg position |
| spellingShingle | Gulsah Karaoren Nurten Bakan Eyüp Veli Kucuk Eyup Gumus Is rhabdomyolysis an anaesthetic complication in patients undergoing robot-assisted radical prostatectomy? Journal of Minimal Access Surgery Acute renal failure comorbidity minimally invasive surgery prostatectomy rhabdomyolysis Trendelenburg position |
| title | Is rhabdomyolysis an anaesthetic complication in patients undergoing robot-assisted radical prostatectomy? |
| title_full | Is rhabdomyolysis an anaesthetic complication in patients undergoing robot-assisted radical prostatectomy? |
| title_fullStr | Is rhabdomyolysis an anaesthetic complication in patients undergoing robot-assisted radical prostatectomy? |
| title_full_unstemmed | Is rhabdomyolysis an anaesthetic complication in patients undergoing robot-assisted radical prostatectomy? |
| title_short | Is rhabdomyolysis an anaesthetic complication in patients undergoing robot-assisted radical prostatectomy? |
| title_sort | is rhabdomyolysis an anaesthetic complication in patients undergoing robot assisted radical prostatectomy |
| topic | Acute renal failure comorbidity minimally invasive surgery prostatectomy rhabdomyolysis Trendelenburg position |
| url | http://www.journalofmas.com/article.asp?issn=0972-9941;year=2017;volume=13;issue=1;spage=29;epage=36;aulast=Karaoren |
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