2 CASES OF RHABDOMYOLYSIS AFTER PROLONGEDENT SURGERY IN THE LATERAL POSITION

Two cases are reported of upper limb rhabdomyolysis occurring after pr olonged ENT cancer surgery, the patient being part of the time in the right lateral position, with the left forearm outstrechted. Surgery co nsisted of a vertical hemilaryngectomy with immediate parascapular fre e graft reconstruction in a 48-year-old man (10 h of surgery, with 6 h in a lateral position) and the surgical removal of a neoplasm involvi ng the mouth floor and larynx in a 62-year-old man including parascapu lar free graft reconstruction (10 h of surgery, with 7 h in a lateral position). In the early postoperative period, the patients complained of severe pain in the left forearm. There was a tense painful swelling of the forearm, combined with an increase in creatinine kinase plasma concentration, and myoglobinaemia. The mechanism involved was most li kely a compression of the forearm muscles, together with prolonged sur gery and the patient position. The part played by the state of the pat ients is discussed. Diagnosis must be made as soon as possible, as the only efficient treatment consists of an early fasciotomy together wit h the administration of alkali to avoid renal failure.