Rhabdomyolysis and Robot-assisted Radical Prostatectomy
Condition: Rhabdomyolysis
MeSH terms: Rhabdomyolysis
Study type: Observational [Patient Registry]

Summary: 
      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 BMI, comorbidities, intraoperative
      positioning, fluid restriction and length of surgery on development of RM in RARP patients
      during perioperative period.
    

Detailed description: 
      Fifty-two ASA I-II patients aged 50-80 years, BMI >25 kg/m2 scheduled for an elective RARP
      were enrolled to the study.

      In all patients, pre-anesthetic evaluations including laboratory tests and Charlson
      Comorbidity Index (CCI) were performed one week before surgery in anesthesia clinic. Comorbid
      diseases were rated based on CCI. A 4-points scale was used to rate comorbid conditions [1
      mild; 4 severe]. Comorbidity grading was performed by adding scores given for each comorbid
      disease. Based on the grading, patients were stratified into 4 groups as follows: grade 0,
      1-2, 3-4 and ≥ 5

      In the operation room, intubation was performed after standard anesthesia For surgery,
      patients were placed in low lithotomy position. All patients were placed on a soft sponge
      mattress and soft padding gel pads were provided above the shoulders. The patients were
      placed in a 30-degree STP after achieving pneumoperitoneum at an intra-abdominal pressure
      level of 15 mmHg. After placing patient to desired position (T0), blood samples were drawn
      for measurements of ABG, Na, Cl, Ca, K, BUN, Cr, AST, ALT, LDH, cTp-I, CK-MB and CPK.

      During the operation, normal saline (1 m/kg/hr) and 6% HES 200/05 (1 ml/kg/hr) infusions were
      applied. Operation time (OT) and Trendelenburg time (TT) were recorded in all patients.

      Blood samples were repeated on the hours 6 (T6), 12 (T12) and 24 (T24) after beginning of
      surgery. Hydration with 2000 ml crystalloid solution was given until hour 24 after surgery.
      In all patients, urine output was monitored.

      Rhabdomyolysis was defined as postoperative serum CPK level exceeding 5,000 IU/L. It was
      planned to manage these patients with hypervolemic therapy, correction of acidosis by using
      IV sodium bicarbonate and stimulation of diuresis by IV furosemide with a goal of maintaining
      minimal diuresis of 60 ml/hr at pH level of 7.

      Postoperative RF was defined as an increase in serum creatinine of 1mg/dl/day (or 90
      mmol/l/day) for 2 consecutive days beyond the baseline.

      Patients were discharged with control laboratory tests, including the same parameters, on the
      hour 48 (T48) postoperatively.
    

Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        patients scheduled for an elective Robot assisted radical prostatectomy were enrolled to
        the study.
      
Keywords: acute renal failure; prostatectomy; minimal invasive surgery