title: [Rhabdomyolysis in morbidly obese patient submitted to gastric bypass and during upper limb revascularization of pediatric patient: case reports.].
abstract: OBJECTIVE
  Rhabdomyolysis is a syndrome caused by skeletal muscle injury. Its etiology is broad with special interest when it is manifested as intra or post-anesthetic complication. This report aimed at describing two cases of rhabdomyolysis in the postoperative period of long procedures in morbidly obese and trauma injury patients, emphasizing its correlation with anesthesia.
  
  
  METHODS
  The first case is a 39-year old, morbidly obese patient, BMI 62, submitted to laparoscopic gastric bypass under general anesthesia. In the postoperative period patient presented upper and lower limbs muscle weakness and changes in sensitivity evolving with muscle pain and reddish urine. Increased creatinokinase (CK) plasma levels confirmed the diagnosis of rhabdomyolysis. Patient was treated with forced and diuretic hydration, has not evolved with renal failure, but was discharged with muscular and neurological sequelae. The second case is a 7-year old child victim of accident with a glass door, who was submitted to emergency procedure for left upper limb revascularization. During anesthesia urine color has changed becoming reddish. Intravenous sodium bicarbonate and mannitol were administered to alkalinize the urine and increase urinary output. Patient was referred to the ICU where rhabdomyolysis was confirmed by increased CK enzyme and myoglobinuria. Patient was discharged 10 days later without sequelae.
  
  
  CONCLUSIONS
  Cases have shown risk factors for rhabdomyolysis and their relationship with anesthesia and surgery. Early diagnosis is critical for a fast and aggressive treatment to prevent more severe complications.
authors.affiliation: Hospital Universitário Clementino Fraga Filho, UFRJ.
authors.forename: Maria Angélica
authors.initials: MA
authors.lastname: Abrão
authors.forename: Renata Gomes
authors.initials: RG
authors.lastname: Ferreira
authors.forename: Paulo Alípio
authors.initials: PA
authors.lastname: Germano Filho
authors.forename: Luiz Cláudio
authors.initials: LC
authors.lastname: Lerner