Intraoperative fluid replacement and postoperative creatine phosphokinase levels in laparoscopic bariatric patients.
BACKGROUND
Morbid obesity and bariatric surgery are both risk factors for the development of postoperative rhabdomyolysis (RML). RML results from injury to skeletal muscle, and a serum creatine phosphokinase (CK) level >1,000 IU/L is considered diagnostic of RML. The aim of this study was to determine if intraoperative intravenous fluid (IVF) volume affects postoperative CK levels following laparoscopic bariatric operations.


METHODS
Prospective, single blinded, and randomized trial was conducted.


METHODS
Patients scheduled to undergo laparoscopic sleeve gastrectomy, adjustable gastric band, or Roux-en-Y gastric bypass operations were randomized into two groups. Subjects in Group A received 15 ml/kg total body weight (TBW) of IV crystalloid solution during surgery, while subjects in Group B received 40 ml/kg TBW. Preoperative and postoperative CK and creatinine levels and intra- and postoperative urine output were monitored and recorded.


RESULTS
Forty-seven patients were assigned to Group A and 53 patients to Group B. Group B patients had significantly higher urine output in the operating room, in the post-anesthesia care unit (PACU), and on postoperative days 0 and 1. Group B patients also had significantly lower serum creatinine level in the PACU and a trend towards lower creatinine levels on postoperative days 0, 1, and 2. There were no statistical differences in CK levels at any time between the two groups. Four patients in Group A and three patients in Group B developed postoperative RML.


CONCLUSIONS
Conservative (15 ml/kg) versus liberal (40 ml/kg) intraoperative IVF administration did not change the incidence of RML in patients undergoing laparoscopic bariatric operations. Since the occurrence of RML in this patient population is relatively high, postoperative CK levels should be routinely obtained in patients at special risk.
Wool
Daniel B
DB
Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
Lemmens
Harry J M
HJ
Brodsky
Jay B
JB
Solomon
Houman
H
Chong
Karen P
KP
Morton
John M
JM
D000328:Adult; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005743:Gastrectomy / Q000379:methods; D015390:Gastric Bypass / Q000379:methods; D015391:Gastroplasty / Q000379:methods; D006801:Humans; D007430:Intraoperative Care; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012206:Rhabdomyolysis / Q000201:enzymology / Q000517:prevention & control; D012307:Risk Factors; D016037:Single-Blind Method; D014556:Urine
D015415:Biomarkers; D003402:Creatine Kinase