Presentation Details
| Perioperative Considerations of Rhabdomyolysis in the Anesthesiologist’s Perspective Simoni Haji1, Garret Weber1, 2, Apolonia Abramowicz1, 2. 1New York Medical College, Valhalla, NY, USA.2Westchester Medical Center, Valhalla, NY, USA |
Abstract
BACKGROUND: Rhabdomyolysis poses significant perioperative challenges due to its release of intracellular contents into the bloodstream.This significance lies in its potential to complicate anesthetic management through a range of outcomes from electrolyte irregularities to acute kidney injury (AKI). Despite its severity, it remains underrecognized in the literature. Our goal is to synthesize the current limited literature to outline the perioperative risk factors, vulnerable populations, treatment and, management, while outlining areas of future research.
METHODS: A targeted literature search using PubMed and EMBASE with the terms “Rhabdomyolysis AND peri- and post op AND anesthesia” yielded 166 results. After excluding non-English, irrelevant, and outdated publications, 62 articles—including reviews, meta-analyses, and case reports—were included. References from selected papers were additionally screened to capture any overlooked yet relevant studies.
RESULTS: Perioperative triggers include volatile anesthetics, prolonged surgical positioning, and underlying metabolic or neuromuscular disorders. Prompt diagnosis is important to differentiate from malignant hyperthermia, and deliver optimal patient outcomes. High-risk patients benefit from close monitoring with ECG, fluid status evaluation, serial blood gases, and creatine kinase (CK) measurements. At risk patient groups were identified to be those with obesity, muscular dystrophies, chronic statin use, and prolonged surgery in prone positioning. Management centers on aggressive fluid resuscitation, correction of electrolyte abnormalities and avoidance of nephrotoxic agents. Postoperative care is critical; patients with marked CK elevation, AKI, or electrolyte instability may require intensive care monitoring, serial laboratory evaluation, and individualized fluid strategies.
CONCLUSIONS: Rhabdomyolysis in the perioperative setting requires a high index of suspicion and prompt but effective management. Prevention is key, and anesthesiologists should plan out specialty cases where clinical suspicion is high to avoid triggering rhabdomyolysis. Future research should aim to develop standardized perioperative protocols based on patient-specific risk profiles and to identify early diagnostic biomarkers that may improve clinical outcomes.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
METHODS: A targeted literature search using PubMed and EMBASE with the terms “Rhabdomyolysis AND peri- and post op AND anesthesia” yielded 166 results. After excluding non-English, irrelevant, and outdated publications, 62 articles—including reviews, meta-analyses, and case reports—were included. References from selected papers were additionally screened to capture any overlooked yet relevant studies.
RESULTS: Perioperative triggers include volatile anesthetics, prolonged surgical positioning, and underlying metabolic or neuromuscular disorders. Prompt diagnosis is important to differentiate from malignant hyperthermia, and deliver optimal patient outcomes. High-risk patients benefit from close monitoring with ECG, fluid status evaluation, serial blood gases, and creatine kinase (CK) measurements. At risk patient groups were identified to be those with obesity, muscular dystrophies, chronic statin use, and prolonged surgery in prone positioning. Management centers on aggressive fluid resuscitation, correction of electrolyte abnormalities and avoidance of nephrotoxic agents. Postoperative care is critical; patients with marked CK elevation, AKI, or electrolyte instability may require intensive care monitoring, serial laboratory evaluation, and individualized fluid strategies.
CONCLUSIONS: Rhabdomyolysis in the perioperative setting requires a high index of suspicion and prompt but effective management. Prevention is key, and anesthesiologists should plan out specialty cases where clinical suspicion is high to avoid triggering rhabdomyolysis. Future research should aim to develop standardized perioperative protocols based on patient-specific risk profiles and to identify early diagnostic biomarkers that may improve clinical outcomes.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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