engleski

Serum myoglobin level during elective craniotomy

Elevated serum levels of Mb sometimes are clinically irrelevant, but possible toxic effects include renal failure, hyperkalemia, respiratory distress syndrome and death. A recent study showed elevated serum levels of Mb after elective neurosurgery (1). An operative procedure lasting more than three hours was the only factor significantly correlated with peak Mb concentration. The pathophysiology and dynamics of serum myoglobin increase are not clearly understood. The aim of our study was to detect possible earlier rises in serum levels of Mb during elective neurosurgery. Therefore, in a prospective observational study, we compared serum Mb levels five minutes before induction of general anesthesia, and 2 hours later during the elective neurosurgery. We tested serum Mb in fifteen neurosurgical patients, ASA 1-3, age 56&#177; 15 yrs. (mean&#177; SD), who underwent elective craniotomy. Exclusion criteria were: hypothyreosis, alcohol abuse, use of statins, heart or skeletal disease and seizures. In a group of eleven patients, serum Mb levels were measured twice: 5 min. before the induction of anesthesia and 2 hours after the first blood sample was drawned. Induction of anesthesia was done by thiopental 5 mg/kg, fentanyl 1, 5 &#181; g/kg and pancuronuim 0, 1 mg/kg. Maintenance of anesthesia was performed with mixture of 33 % oxygen with 67 % nitrous oxide and continuous infusion of thiopental 5-8 mg/kg/h and fentanyl 1 &#181; g/kg/h. Serum Mb was measured by immunonephelometry. Statistical analysis was done by paired t-test for small dependent samples. P value < 0, 05 was considered significant. Data (mean&#177; SD) are shown in the table: Myoglobin level Mean (&#956; g/L) SD N = 11 Before induction 47.49 20.39 t = 3.24 2 hours later 75.50 29.17 p = 0.0088. There was a statistically significant increase of serum Mb level in neurosurgical patients, observed two hours after the induction of general anesthesia. References: 1. Poli D., Gemma M., Cozzi S., Lugani D., Germagnoli L., Beretta L.: Muscle enzyme elevation after elective neurosurgery ; Eur. J. Anaesthesiol. 2007 ; 24(6):551-555.

myoglobin; elective craniotomy

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