Table 4.

Suggestions for the prevention and management of surgical position-related rhabdomyolysis

Preoperative

Identify patient risk factors: obesity, hypovolemia, diabetes mellitus, hypertension, chronic kidney disease, peripheral vascular disease, expected surgery time longer than 5 h

The vascular status of the patient’s lower extremity should be carefully assessed with a well-documented preoperative vascular examination

The patient´s volume status should be evaluated

Intraoperative

Ensure correct patient positioning and protect all pressure points

Monitor lower extremities and vascular status

Reposition lower extremities every two hours

Adequate fluid reposition, avoiding hypovolemia

Monitor serum potassium levels

Appropriate operative time, completing the procedure as quickly as possible

Post-operative

Assess serum-CK and SCr 6 h and 18 h postoperatively in high-risk patients

Closely check serum creatinine, potassium levels, and acid-base disorders

Apply KDIGO AKI definitions to AKI diagnosis

Monitor signs of compartmental syndrome and consider fasciotomy if present

If RM syndrome is diagnosed, initiate medical treatment:

Initiate aggressive early fluid repletion;

Treat acid-base and electrolyte abnormalities;

Consider early RRT

CK: Creatine kinase; KDIGO: Kidney disease improving global outcomes; RM: Rhabdomyolysis; RRT: Renal replacement therapy; SCr: Serum creatinine. AKI: Acute kidney injury.