Rhabdomyolysis and Myonecrosis in a Patient in the Lateral Decubitus Position

Abstract

(Mathes) Assistant Professor, Department of Anesthesia.(Assimos) Associate Professor, Department of Urology.(Donofrio) Associate Professor, Department of Neurology.Received from the Departments of Anesthesia, Urology, and Neurology, The Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina. Submitted for publication September 1, 1995. Accepted for publication November 28, 1995.Address correspondence and reprint requests to Dr. Mathes: Department of Anesthesia, The Bowman Gray School of Medicine of Wake Forest University, Medical Center Boulevard, Winston-Salem, North Carolina 27157–1009.RHABDOMYOLYSIS, from muscle necrosis, is known to occur in certain surgical positions, most notably the dorsal lithotomy and knee chest. This complication is often attributed to compromise of venous and arterial blood flow. Several cases of rhabdomyolysis and gluteal myonecrosis have been reported to occur in patients in the lateral decubitus position undergoing hip surgery. These complications have been attributed to the posterior clamp pressing directly on the buttocks instead of the sacrum area and to the anterior public clamp being placed against the anterior part of the dependent thigh, causing vascular compromise at the groin. [1,2]We report a case of rhabdomyolysis occurring solely from the direct and prolonged pressure of the operating room bed against the gluteal and flank muscles in a patient in the lateral decubitus position.A 29-yr-old, 110-kg man with a long history of recurrent left nephrolithiasis underwent partial left nephrectomy for a large left upper pole calyceal diverticulum with