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BJA Advance Access published online on April 4, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael077
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted February 25, 2006

Clinical Investigation

Changes in creatine phosphokinase (CK) concentrations after minor and major surgeries in children

M. A. Yousef 1, S. Vaida 2, M. Somri 2, J. Mogilner 3, A. Lanir 4, A. Tamir 5, and R. Shaoul 1 *

1 Department of Paediatrics, Bnai Zion Medical Center, Haifa, Israel
2 Department of Anaesthesiology, Bnai Zion Medical Center, Haifa, Israel
3 Department of Paediatric Surgery, Bnai Zion Medical Center, Haifa, Israel
4 Department of Clinical Biochemistry, Bnai Zion Medical Center, Haifa, Israel
5 Department of Community Medicine, Faculty of Medicine, Technion, Haifa, Israel

* To whom correspondence should be addressed.
R. Shaoul, E-mail: shaoul_r{at}012.net.il


  Abstract

Background. During surgery, damage occurs to muscles in the area of the operation. The few studies that have examined creatine phosphokinase (CK) values after surgery have been in adults. The only study in children was after cardiac surgery. Understanding the normal enzyme pattern of change may help to differentiate malignant hyperthermia, anaesthesia-induced rhabdomyolysis and elevated CK values resulting from inherited muscle disease in cases in which these are suspected. The aim of this study was to delineate the normal rise of CK after minor and major surgery in children.

Methods. A total of 71 patients aged 1 month-17 yr were studied. From the cohort of 71 patients, 46 underwent elective surgery (14 major, 32 minor) and in 25 the surgery was designated as an emergency surgery (21 major, 4 minor). The anaesthesia protocol was similar for both groups with halothane induction and isoflurane maintenance. Owing to its possible effect on CK, succinylcholine was avoided during the study.

Results. The mean values of CK concentration before and after surgery were 63.1 iu litre-1 and 151.5 iu litre-1, respectively. The median CK elevation (range) for the major and minor surgery groups was 43 iu litre-1 (4-647) and 10 iu litre-1 (-28 to 122), respectively (P<0.0001).

Conclusions. CK concentrations in the major surgery group were significantly higher than the minor surgery group. This profile can contribute to the evaluation of patients who present with the possibility of malignant hyperthermia, anaesthesia-induced rhabdomyolysis and underlying muscle disease. Any rise of CK concentration above what is expected should prompt further investigation.

Keywords: children; enzymes, creatine phosphokinase; measurement techniques, concentrations, postoperative; measurement techniques, concentrations, preoperative; surgery.
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