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

Area of Science:

• Pediatric Anesthesiology
• Clinical Biochemistry
• Surgical Patient Management

Background:

• Surgical procedures inherently cause muscle damage, leading to elevated creatine phosphokinase (CK) levels.
• Limited research exists on post-surgical CK patterns in children, with prior studies focusing on adults or pediatric cardiac surgery.
• Understanding normal CK changes aids in differentiating surgical-related elevations from serious conditions like malignant hyperthermia, anesthesia-induced rhabdomyolysis, or inherited myopathies.

Purpose of the Study:

• To establish the typical pattern of creatine phosphokinase (CK) elevation following both minor and major surgical interventions in pediatric patients.
• To provide a baseline for interpreting elevated CK levels in children suspected of having specific muscle-related disorders.

Main Methods:

• A cohort of 71 pediatric patients (1 month to 17 years) was studied.
• Patients underwent either elective (14 major, 32 minor) or emergency (21 major, 4 minor) surgery.
• A standardized anesthesia protocol using halothane induction and isoflurane maintenance was employed, with succinylcholine avoided due to potential CK effects.

Main Results:

• Mean CK concentrations increased from 63.1 IU/L pre-operatively to 151.5 IU/L post-operatively.
• Median CK elevation was significantly greater in the major surgery group (43 IU/L) compared to the minor surgery group (10 IU/L) (P<0.0001).

Conclusions:

• Children undergoing major surgery exhibit significantly higher post-operative CK levels than those undergoing minor surgery.
• This established CK profile is valuable for evaluating pediatric patients presenting with suspected malignant hyperthermia, anesthesia-induced rhabdomyolysis, or underlying muscle diseases.
• Elevated CK levels exceeding expected surgical-related rises warrant further investigation to rule out pathological conditions.