IV Sedation for Cases of Extended Length Using Either Diazepam With Hydromorphone or Midazolam With Fentanyl

Abstract

In these cases, like most oral and maxillofacial surgical cases, the patients did not have significant risk factors for rhabdomyolysis aside from prolonged operative time; though both patients had borderline hypertension and the second patient had elevated body mass index (38.5). In both cases, rhabdomyolysis is likely due to directmuscle breakdown from the surgical table padding and prolonged surgical time, possibly exacerbated by insufficient fluid resuscitation and prolonged hypotension. Incaseswhereprolongedsurgical time is anticipated,procedures may be divided into two stages to avoid prolonged muscle compression. Routine intraoperative repositioning andpressurepoint checks are recommended, andpostoperativemeasurements of the serum creatine kinase and serum creatinine levels for prolonged surgeries. If a diagnosis of rhabdomyolysis is confirmed, aggressive fluid resuscitation may prevent acute kidney injury. In these two cases, patient one had AKIwith CKelevation to 39,500 U/L, while patient two did not have AKI, but had CK elevation greater than 100,000 U/L, thus in this small sample, there is no clear correlation betweenAKI andCKelevation. A prospective study of patients undergoing maxillofacial surgery is planned to determine if direct correlations exist between operative length, intentional hypotension, BMI and CK levels.