ABSTRACT
Serum creatine kinase [CK] is the gold standard marker for muscle injury. Any muscle damage, if severe enough, can lead to rhabdomyolysis [RM] and subsequent renal failure if not treated properly. This is usually correlated with high levels of creatine kinase. Spine interventions in orthopaedic surgery are associated with surgical "injury" to the back muscles and abnormal levels of creatine kinase. Rhabdomyolysis associated with spine surgery is in fact multifactorial, and most commonly due to prolonged surgery time and certain operative positions, correlated with high risk of developing compartment syndrome [CS]. However, the final complication of acute renal failure is exceptional in these procedures. This paper reviews all reported cases of rhabdomyolysis and acute renal failure following spinal interventions, and discusses the role of creatine kinase in the evaluation of muscle injury as a predictor of rhabdomyolysis and acute renal failure. Most spine surgeries are in fact not correlated with rhabdomyolysis and acute renal failure as this correlates with very high levels of creatine kinase. As a result, monitoring creatine kinase is only advised to follow in certain circumstances, and will only lead to unnecessary expenses
ABSTRACT
Background : Low molecular weight heparins are replacing unfractionated heparin in practice prior to cardiac surgery. This study examines postoperative [post-op] bleeding indicators in patients who received enoxaparin and underwent elective isolated first time coronary artery bypass graft
Methods: A total of 125 consecutive patients who underwent this procedure between 2009 and 2011 at one tertiary center were reviewed and divided into three groups : Group A[n = 50] received the last dose of enoxaparin between 12 and 24 hours before surgery, Group B [n = 25] received the last dose before 24 hours and Group C [n = 50] did not receive enoxaparin. Perioperative bleeding indicators and transfusion rates were compared
Results : Preoperative patients' characteristics were comparable between the three groups. There were no perioperative deaths, return to the operating room for any reason, nor major bleeding. Post-op bleeding indicators were similar in the three groups. The average chest tube drainage at 24 hours post-op was 880 mL, 695 mL and 830 mL in Group A, B and C respectively [p = 0.71]. Transfusion rates of red blood cells were not statistically different [Group A 56%, B 64% and C 62% ; p = 0.747]. In multivariate analysis, female gender, older age, and preoperative clopidogrel intake [stopped 5 days prior to surgery] were associated with higher transfusion rates
Conclusion: In elective first time coronary artery bypass graft patients who had no aspirin or clopidogrel intake 5 days prior to surgery, the use of enoxaparin up to 12 hours prior to skin incision does not increase the risk of post-op bleeding