INCREASE IN SERUM CREATINE-PHOSPHOKINASE CONCENTRATIONS AFTER SUXAMETHONIUM DURING SEVOFLURANE OR ISOFLURANE ANESTHESIA IN CHILDREN

We have studied whether sevoflurane or isoflurane anaesthesia modulate s the effect of suxamethonium on serum concentrations of enzyme marker s of skeletal muscle function in paediatric patients. Eighty patients undergoing bilateral tonsillectomy, aged 5-12 yr, were allocated rando mly to receive anaesthesia with either sevoflurane and nitrous oxide o r isoflurane and nitrous oxide. Serum creatine phosphokinase (CK), asp artate aminotransferase (AST), alanine aminotransferase (ALT) and lact ate dehydrogenase (LDH) concentrations were measured before, and at 30 min and 20 h after induction of anaesthesia. Mean CK concentrations i ncreased from 97.0 (SD 17.3) to 478 (170) iu litre(-1) in the sevoflur ane group and from 86.9 (22.4) to 628 (223) iu litre(-1) in the isoflu rane group, 20 h after induction of anaesthesia. Mean peak serum CK co ncentration in the sevoflurane group (478 (170) iu litre(-1)) was sign ificantly less (P <0.05) than that in the isoflurane group (628 (223) iu litre(-1)). Mean serum AST concentration increased from 17.5 (4.9) to 31.7 (3.5) iu litre(-1) in the sevoflurane group and from 77.3 (2.4 ) to 34.8 (5.7) iu litre(-1) in the isoflurane group, 20 h after induc tion of anaesthesia. Mean peak serum AST concentrations in the sevoflu rane group were significantly lower (P <0.05) than those in the isoflu rane group. There were no significant differences in serum ALT or LDH concentrations between the groups either before or after anaesthesia. We conclude that administration of suxamethonium during either sevoflu rane or isoflurane anaesthesia caused a marked increase in serum CK co ncentrations in paediatric patients. The clinical significance of this finding is uncertain.