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Muscle enzyme elevation after elective neurosurgery

Published online by Cambridge University Press:  01 June 2007

D. Poli ,
M. Gemma ,
S. Cozzi ,
D. Lugani ,
L. Germagnoli  and
L. Beretta
D. Poli
Affiliation:
Università Vita e Salute, S. Raffaele Hospital, *Neurosurgical Anesthesia and Intensive Care Unit, Milano, Italy
M. Gemma*
Affiliation:
Università Vita e Salute, S. Raffaele Hospital, *Neurosurgical Anesthesia and Intensive Care Unit, Milano, Italy
S. Cozzi
Affiliation:
Università Vita e Salute, S. Raffaele Hospital, *Neurosurgical Anesthesia and Intensive Care Unit, Milano, Italy
D. Lugani
Affiliation:
Università Vita e Salute, S. Raffaele Hospital, *Neurosurgical Anesthesia and Intensive Care Unit, Milano, Italy
L. Germagnoli
Affiliation:
Università Vita e Salute, S. Raffaele Hospital, Clinical Biochemistry Laboratory, Milano, Italy
L. Beretta
Affiliation:
Università Vita e Salute, S. Raffaele Hospital, *Neurosurgical Anesthesia and Intensive Care Unit, Milano, Italy
*
Correspondence to: Dr Marco Gemma, Neurorianimazione – Ospedale S. Raffaele, Via Olgettina, 60, 20132 Milano, Italy. E-mail: gemma.marco@hsr.it; Tel: +39 02 2643 3333; Fax: +39 02 2643 7863
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Summary

Background

Serum creatine kinase and myoglobin elevation has been described involving muscle manipulation after surgery and also after bariatric, urologic and gynaecologic procedures. It encompasses a wide range of severity, reflecting in the worst cases true rhabdomyolysis. We occasionally noted creatine kinase elevations after intracranial neurosurgery, an occurrence that has not yet been described. To assess whether the issue of postoperative muscle enzyme elevation is relevant to neurosurgery, we prospectively measured serum creatine kinase and myoglobin in a series of neurosurgical patients submitted to craniotomy.

Materials and methods

We studied 30 patients aged 22–69 yr submitted to craniotomy. Blood samples were taken prior to the procedure, at the end of anaesthesia and on the first, second and third postoperative days. Blood was checked for creatine kinase, myoglobin, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, creatinine and serum electrolytes. We recorded the patient’s age, sex, height, weight and body mass index. Throughout surgery, we recorded the highest and the lowest body temperature and sampled the mean arterial pressure at 5 min intervals. We performed backwards stepwise logistic regression analysis to identify the elements that best correlate with the development of cell muscle damage.

Results

On the first postoperative day creatine kinase peaked from baseline (305 (107–1306) UI L−1 vs. 59 (42–94) UI L−1; P < 0.001) while myoglobin rose significantly from baseline to the end of surgery (70 (42–147) ng mL−1 vs. 36 (30–44) ng mL−1; P = 0.002). Logistic regression showed that length of surgery was the only factor clearly influencing peak creatine kinase (P < 0.001; R2 0.7) and myoglobin (P = 0.011; R2 0.41) concentration.

Conclusions

Creatine kinase and myoglobin elevation may occur after intracranial neurosurgery. In our series, length of surgery was a risk factor.

Keywords

NEUROSURGICAL PROCEDURES, craniotomyRHABDOMYOLYSISMYOGLOBINCREATINE KINASE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 6 , June 2007 , pp. 551 - 555
Copyright
Copyright © European Society of Anaesthesiology 2007

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Footnotes

The present work has been conducted with the institutional support of the S. Raffaele Hospital in Milan, Italy.

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