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[A case of elevated serum creatine-kinase after anesthesia]
K Tanabe1, T Ishiyama, A Suzuki
1Department of Anesthesia, Daiyuukai General Hospital, Ichinomiya.
Insights
Postoperative creatine kinase (CK) elevation after cerebral aneurysm surgery, linked to fever and dark urine, suggests sympathetic nervous system activation. This finding is crucial for understanding neurological event complications.
Area of Science:
- Neurology
- Anesthesiology
- Biochemistry
Background:
- Cerebral aneurysm surgery presents complex anesthetic challenges.
- Postoperative monitoring for complications like elevated creatine kinase (CK) is essential.
Observation:
- A 50-year-old male exhibited markedly elevated serum CK levels (5919 IU/L) post-cerebral aneurysm surgery.
- This elevation coincided with hyperthermia (>39.5°C) and port-wine colored urine.
Findings:
- Elevated CK levels normalized within six days post-surgery.
- Myocardial infarction, malignant hyperthermia, and drug effects were ruled out as causes.
Implications:
- The study suggests sympathetic nervous system stimulation secondary to cerebral bleeding may cause significant CK elevation.
- Increased skeletal muscle sarcolemma permeability is implicated in this phenomenon.
- This case highlights a potential biomarker for neurological complications post-neurosurgery.
Abstract:
An elevation of creatine-kinase was noted postoperatively in a 50 year-old male who had cerebral aneurysm surgery under isoflurane, N2O and O2 anesthesia. Serum CK concentration reached as high as 5919 IU.l-1 immediately after surgery and elevation was associated with the temperature elevation of above 39.5 degrees C and port-wine urine. The postoperative course was uneventful and elevated serum creatine-kinase was corrected within next 6 days. Since elevated serum creatine-kinase is known to occur in acute stage of cerebrovascular accident, and since the influence of myocardial infarction, malignant hyperthermia and drugs could be neglected, we assumed that an abnormal elevation of CK values observed in the present patient resulted from stimulation of sympathetic nervous system due to cerebral bleeding and to hyperpermeability of sarcolemma of skeletal muscle.