Serum creatine phosphokinase, lactic dehydrogenase, and their isoenzymes in the perioperative period

Supercapsular percutaneously-assisted total hip (SuperPath) versus mini-incision posterolateral total hip arthroplasty for hip osteoarthritis: a prospective randomized controlled trial

Background

Supercapsular percutaneously-assisted total hip (SuperPath) arthroplasty has been proposed to be minimally invasive and tissue sparing, with possible superior postoperative outcomes compared with conventional approaches for total hip arthroplasty (THA). However, previous studies have underlined the shortcomings of conventional THA approaches, including higher dislocation, more blood loss, longer incisions, more tissue damage, and delayed postoperative rehabilitation. In the present study, we compared the short-term outcomes of unilateral THA with those of SuperPath and the mini-incision posterolateral approach (PLA) for hip osteoarthritis (OA).

Methods

Patients with unilateral hip OA were prospectively recruited and underwent either SuperPath (SuperPath group) or mini-incision PLA THA (PLA group). Perioperative status [operative time, incision length, intraoperative blood loss, soft tissue damage, and length of hospital stay (LOS)], and postoperative function outcomes, including range of motion (ROM), pain visual analog scale (VAS), and Harris Hip Score (HHS), were evaluated and compared between the groups at scheduled time points within 12 months postoperatively.

Results

Compared with the PLA group, the SuperPath group yielded a significantly shorter incision length (7.83 vs. 12.45 cm, P<0.001), longer operative time (102.72 vs. 66.22 min, P<0.001), more blood loss (1,007.38 vs. 844.55 mL, P=0.005), and more soft tissue damage (creatine kinase: 1,056.05 vs. 821.50 U/L, P=0.006) on postoperative day 3. The SuperPath group also showed deficient acetabular cup positioning (abduction angle: 36.94° vs. 42.66°, P=0.004) and a greater decrease in ROM (flexion: 107.66° vs. 114.44°, P=0.004; 109.83° vs. 116.11°, P=0.002; 111.66° vs. 118.88°, P<0.001) on postoperative days 1, 3, and 14, as well as severe early-term pain symptoms (pain VAS on postoperative day 3: 7.05 vs. 6.55, P=0.041). However, the LOS, C-reactive protein levels, erythrocyte sedimentation rate (within 2 weeks postoperatively), and HHS were comparable between the groups during the 12 months postoperatively.

Conclusions

SuperPath may be a promising, minimally invasive technique for the treatment of OA in the future. Further investigation is necessary to evidence the possible superiority of SuperPath over other conventional mini-incision THA approaches.

Postoperative changes in serum creatine kinase in paediatric orthopaedic patients with preoperative hyperCKaemia: review of three cases

An elevated serum creatine kinase (CK) level is commonly known as hyperCKaemia, and anaesthesiologists must take into account the potential susceptibility of hyperCKaemia patients to develop malignant hyperthermia during general anaesthesia as well as acute onset of rhabdomyolysis postoperatively. Three paediatric patients with hyperCKaemia were scheduled for orthopaedic surgery. With the consent of their parents, their CK changes were monitored for seven days postoperatively to detect rhabdomyolysis. The results showed that the postoperative CK change patterns were almost the same as those for patients whose CK levels were within reference range. Maximum CK levels tended to be higher in these patients than in the CK reference-range patients studied previously, although the reason remains unclear. This experience and previous studies suggest that measuring CK levels at least on postoperative days 1 and 2 might be better for detecting early signs of rhabdomyolysis, even in paediatric patients with hyperCKaemia.

Tissue injuries after single-port and multiport laparoscopic gynecologic surgeries: A prospective multicenter study

The present study focused on the degree of tissue injury following single-port laparoscopic surgery (SPLS) and multiport laparoscopic surgery (MPLS) for the treatment of various benign gynecologic diseases. A total of 228 patients were prospectively enrolled at seven academic centers in South Korea between April 2011 and September 2012. Of these, 122 patients underwent SPLS and 106 patients underwent MPLS. The serum levels of C-reactive protein, creatine phosphokinase, lactic dehydrogenase and cancer antigen 125 were measured preoperatively and on postoperative day 4 by immunonephelometry. Cosmetic satisfaction and postoperative pain scores (visual analogue scale) were analyzed. Postoperative changes in the levels of the serum markers were found to be similar between the SPLS and MPLS groups. However, the postoperative pain scores at 48 h were significantly lower in the SPLS group when compared with those in the MPLS (P=0.001). In addition, patient-controlled analgesia was used more frequently by patients in the MPLS group (P=0.003). The present study is the first prospective investigation of tissue injury resulting from SPLS and MPLS in gynecology. In conclusion, the current study demonstrated that serum marker levels during SPLS were similar to those during MPLS in the treatment of benign gynecologic diseases. However, SPLS is a reasonable alternative to MPLS and is associated with comparable tissue injury, improved cosmesis and reduced postoperative pain.

Tissue Trauma in Abdominal and Laparoscopic-Assisted Vaginal Hysterectomy

STUDY OBJECTIVE

To compare the degree of tissue damage between abdominal and laparoscopic-assisted hysterectomy.

DESIGN

Prospective, randomized, controlled study (Canadian Task Force classification I).

SETTING

University hospital.

PATIENTS

Forty-six women.

INTERVENTION

Laparoscopic-assisted and abdominal hysterectomy.

MEASUREMENTS AND MAIN RESULTS

The degree of tissue injury caused by surgical trauma was assessed by measuring plasma levels of creatine phosphokinase (CPK), C-reactive protein (CRP), lactic dehydrogenase (LDH), and CA 125 in patients undergoing laparoscopic-assisted (n = 23) and abdominal hysterectomy (n = 23). Plasma levels of CPK-MB isoenzyme were measured in order to exclude the possibility of myocardial injury. Blood samples were taken preoperatively, and on the first and second postoperative days. There was no difference in demographic characteristics between the groups. One patient in the laparotomy group and two patients in the laparoscopy group were excluded from analysis due to bladder injury, postoperative thrombophlebitis, and conversion to laparotomy because of severe adhesions. The mean operation time was longer (105.5 +/- 23.1 minutes vs 77.3 +/- 18.7 minutes, p < .001), but the duration of hospital stay was shorter (2.7 +/- 0.8 days vs 4.3 +/- 1.4 days, p < .001) and analgesic requirement was lower in the laparoscopy group compared with the abdominal group. We observed significant postoperative increases in CRP and CPK in both groups on postoperative days 1 and 2, whereas the increase in LDH was significant only in the laparotomy group on postoperative day 2. There were no significant changes in CPK-MB and CA 125. Moreover, mean plasma levels of CRP and CPK were significantly higher in the laparotomy group on postoperative days 1 and 2 than in the laparoscopy group (p < .05).

CONCLUSION

Surgery is a significant cause of tissue injury that can be assessed by specific enzymes and proteins. We suggest that laparoscopic surgery causes less tissue damage as assessed by lower postoperative CRP and CPK values, and that less tissue trauma related with laparoscopic surgery may account for early mobilization and reduced analgesic requirement in these patients.

Hypertensive crisis inducing rhabdomyolysis during laparoscopic resection of a large pheochromocytoma: a case report

Intense vasospasm during hypertensive crisis as a cause for rhabdomyolysis has been described in ambulatory patients with pheochromocytoma. We report this phenomenon as an intraoperative complication in a patient during laparoscopic pheochromocytoma resection and discuss patient and procedure related risk factors. Unexplained intraoperative hyperkalemia following a severe hypertensive episode during surgery may be a first sign of rhabdomyolysis. Anesthesiologists should be aware of such a possibility. Intra- and postoperative serial electrolyte determinations and if suspected, timely screening for myoglobiuria, may aid in early detection and treatment of intraoperative rhabdomyolysis during pheochromocytoma resections.

Acute renal failure after radiofrequency liver ablation of metastatic carcinoid tumor

IMPLICATIONS

We report a case of prolonged radiofrequency liver ablation for metastatic carcinoid tumor complicated by hemolysis, rhabdomyolysis, and transient acute renal failure. Brief radiofrequency liver ablation procedures or those for a small number of tumor sites are not associated with these complications.