title: Intraoperative fluid replacement and postoperative creatine phosphokinase levels in laparoscopic bariatric patients.
abstract: 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.
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Wool
authors.forename: Harry J M
authors.initials: HJ
authors.lastname: Lemmens
authors.forename: Jay B
authors.initials: JB
authors.lastname: Brodsky
authors.forename: Houman
authors.initials: H
authors.lastname: Solomon
authors.forename: Karen P
authors.initials: KP
authors.lastname: Chong
authors.forename: John M
authors.initials: JM
authors.lastname: Morton
mesh_terms: 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
chemical_list: D015415:Biomarkers; D003402:Creatine Kinase