naa a22 4500 510743587 CHVBK 20180411083037.0 cr unu---uuuuu 180411e20130301xx s 000 0 eng 10.1007/s12630-012-9823-4 doi (NATIONALLICENCE)springer-10.1007/s12630-012-9823-4 Case report: Rhabdomyolysis in morbidly obese patients: anesthetic considerations [Elektronische Daten] [Saravanan Ankichetty, Pamela Angle, Clarita Margarido, Stephen Halpern] Présentation de cas: Rhabdomyolyse chez les patients obèses morbides: considérations anesthésiques 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 54kg·m-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 18,392IU·L-1 and serum potassium of 5.3mmol·L-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 follow-up 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. Canadian Anesthesiologists' Society, 2012 Ankichetty Saravanan Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, M5 318a, M4N 3M5, Toronto, ON, Canada aut Angle Pamela Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, M5 318a, M4N 3M5, Toronto, ON, Canada aut Margarido Clarita Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, M5 318a, M4N 3M5, Toronto, ON, Canada aut Halpern Stephen Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, M5 318a, M4N 3M5, Toronto, ON, Canada aut Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/3(2013-03-01), 290-293 0832-610X 60:3<290 2013 60 12630 https://doi.org/10.1007/s12630-012-9823-4 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12630-012-9823-4 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Ankichetty Saravanan Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, M5 318a, M4N 3M5, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Angle Pamela Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, M5 318a, M4N 3M5, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Margarido Clarita Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, M5 318a, M4N 3M5, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Halpern Stephen Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, M5 318a, M4N 3M5, Toronto, ON, Canada aut NATIONALLICENCE 773 0- Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/3(2013-03-01), 290-293 0832-610X 60:3<290 2013 60 12630 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer