Influence of intraoperative fluid administration on creatine kinase, and its effect on kidney function after laparoscopic nephrectomy

Background
Creatine kinase (CK) is a muscle-specific enzyme, which can be associated with muscle tissue damage. Rhabdomyolysis is a serious postoperative complication following severe muscle destruction. Lengthy procedures, high body mass index and lateral decubitus position are common risk factors.
Objectives
The objective of this study was to investigate the effect of intraoperative fluid administration with two different volumes on CK levels, kidney function and the incidence of rhabdomyolysis after laparoscopic nephrectomy.
Methods
In this prospective randomized study, 100 adult patients, ASA physical status II and III scheduled for laparoscopic nephrectomy were included and, randomized into two equal groups. Patients in Group I received maintenance infusion of Lactated Ringer's solution 4 ml kg h, while patients in Group II received intraoperative infusion 8 ml kg h till the end of surgery. Total intraoperative fluid, urine output and, blood loss were all calculated. CK was measured preoperative (), immediately postoperative (), 12 h postoperative () and at 24, 48, 72 and, 96 h postoperative (–). Serum creatinine was measured preoperative {baseline ()}, 12 h postoperative () then, daily for 3 days (–). Skin changes as erythema and, induration were monitored.
Results
Insignificant differences were reported between the two groups in terms of patient demographics, operative time, intraoperative blood loss and serum creatinine. Intraoperative fluid intake was significantly higher among patients of Group II {2388 (308.8) vs 1284 (233.3) ml}. CK levels were higher in Group I patients in the first 72 h after surgery. Rhabdomyolysis was diagnosed in six patients (6%); only one had elevated serum creatinine and oliguria.
Conclusions
Intraoperative administration of 8 ml kg h compared with 4 ml kg h Lactated Ringer's solution led to significant reduction in CK levels as a marker of rhabdomyolysis during laparoscopic nephrectomy.