Intraoperative factors

1. Positional,pressure/stretch damage.The mechanism of muscle damage that occurs when patients with normal muscle have surgery for long periods in certain positions is not known precisely. However, pressure/stretch damage, followed by ischaemia and reperfusion may all contribute. Large numbers of reports of rhabdomyolysis have occurred, in association with prolonged surgery in the following positions.The majority of the operations lasted in excess of 6 h and evidence of compartment syndrome could be found in the relevant muscles.

a) The Lloyd-Davies/extended/exaggerated lithotomy position for rectal or prostate surgery (Lydon & Spielman 1984,Ali et al 1993).A patient in the lithotomy position

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