title: Elevated serum creatine kinase after neurosurgeries in lateral position with intraoperative neurophysiological monitoring is associated with OP duration, BMI and age.
abstract: OBJECTIVE
  Elevated serum levels of creatine kinase (CK) reflect skeletal muscle injury, which may lead to renal dysfunction following surgery. High CK levels are known to occur after neurosurgical interventions, especially following lateral positioning, but a consensus on possible risk factors is still lacking. Here we investigate risk factors for postoperative CK excess in a patient population at high risk (lateral position) with a special focus on the influence of intraoperative neurophysiological monitoring (IONM), particularly Motor Evoked Potentials (MEPs).
  
  
  METHODS
  We analyzed patient charts from elective surgeries in lateral position between 2010 and 2012 and where IONM was performed and where postoperative CK-levels were available. In these patients, the anesthesia regimen excluded muscle relaxants. Patient charts were reviewed retrospectively for patient characteristics, CK levels and indicators of renal dysfunction. The MEP response intensity was measured. These patients were compared to a matched (age, BMI, surgery duration) control group of patients operated with IONM, but operated in prone or supine position.
  
  
  RESULTS
  We included 96 patients (55 female, mean age 50years). The maximal CK level (CKmax) occurred on postoperative days 2 or 3 (mean 1763U/L). In a multivariate linear regression model, log(CKmax) correlated positively with duration of surgery (p<0.001) and BMI (p=0.007), and negatively with age (p=0.007), but not with MEP response intensity (p=0.481). We did not observe impaired renal function.
  
  
  CONCLUSIONS
  CK excess following neurosurgical procedures in lateral position correlated positively with duration of surgery and BMI and negatively with age. MEP stimulations of the muscles at risk did not cause further CK elevation.
  
  
  CONCLUSIONS
  In patients undergoing long neurosurgeries without muscle relaxants, we recommend special care regarding positioning and perioperative management.
authors: Neurosurgery Department, University Hospital Zurich, Switzerland.
authors: Marian C
authors: MC
authors: Neidert
authors: Neurosurgery Department, University Hospital Zurich, Switzerland.
authors: Marco
authors: M
authors: Losa
authors: Neurosurgery Department, University Hospital Zurich, Switzerland.
authors: Luca
authors: L
authors: Regli
authors: Neurosurgery Department, University Hospital Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Switzerland. Electronic address: johannes.sarnthein@usz.ch.
authors: Johannes
authors: J
authors: Sarnthein
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D003402:Creatine Kinase / Q000097:blood*; D019054:Evoked Potentials, Motor / Q000502:physiology; D005260:Female; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000639:trends; D056888:Patient Positioning / Q000009:adverse effects* / Q000639:trends; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D015415:Biomarkers; D003402:Creatine Kinase
keywords: Creatine kinase (CK); Intraoperative neurophysiological monitoring (IONM); Lateral position; Motor Evoked Potentials (MEP); Neurosurgery