Rhabdomyolysis in head and neck surgery

Rhabdomyolysis is increasingly recognized as a cause of acute renal failure. Although it is often the result of extensive trauma, rhabdomyolysis may also appear as a rare and serious complication during the postoperative period. Postoperative rhabdomyolysis is a rare but serious complication. Early diagnosis of postoperative rhabdomyolysis is based on laboratory tests and clinical examination. Renal hyperperfusion with hydration and diuretics may prevent a nephrotoxic reaction. We describe two recent cases in patients undergoing head and neck surgery.

Between 2007 and 2010, 22 patients with advanced pharyngo laryngeal cancer were treated. Patients records were retrospectively analyzed for preoperative, operative, postoperative, and convalescence data. Demographics, co-morbidities, duration of operation, and postoperative creatine kinase (CK) levels were evaluated.

All patients (n = 20 men; n = 2 women) underwent (pharyngo)laryngectomy to treat advanced (stage T4) head and neck tumors. The mean surgical procedure time among these patients was 6.4 h. (range 5.0 to 7.5 h.). The mean peak serum CK was 1725 U/L (range 456 to 3745 U/L). The mean rise of CK level was 268 U/L, in affected patients ranged from 2636 to 3745 U/L. Rhabdomyolysis occurred in two patients, presenting as excessive, immediate postoperative muscular pain in the "downside" hip/flank. These two patients experienced acute renal failure with an average peak CK of 2700 U/L. Bicarbonate alkalinization and diuretic administration were initiated at a mean of 24 h. (range, 4 to 48 h.). One patient required hemodialysis for 1 month postoperatively, but had stable serum within 2 months. Patients did not experience extended recovery.

Early recognition and aggressive treatment with intravenous fluids and diuresis may prevent the development of acute renal failure due to rhabdomyolysis. Rhabdomyolysis causing acute renal failure is a rare but serious postoperative complication. Adequate prevention in high-risk patients, early diagnosis and, aggressive treatment are the keys to a successful recovery.