Comparison of Emergence Agitation Scale Scores and Creatine Kinase Levels After General Anesthesia in Children: A Prospective Cohort Study

Introduction A simple indicator of muscle damage is creatine kinase (CK). Although CK elevation is informative for malignant hyperthermia, no study has examined the relationship between the anesthetically awake state and CK in children. We aimed to prospectively examine the relationship between the awakening state and CK on the day after surgery in children who have undergone anesthesia with volatile inhalation anesthetics. Methods The study included 119 patients aged 0-15 years and scheduled to undergo general anesthesia for cleft lip and palate-related surgery. Emergence agitation (EA) was assessed after completion of general anesthesia using the five-point EA scale, and patients were divided into the following five groups according to the EA score: EA1, EA2, EA3, EA4, and EA5. The primary outcome was Delta CK (comparison of CK values one week prior to surgery to CK values on the day after surgery) in each EA group. The secondary outcome was Delta CK when the EA score was divided into the following two groups: EA <= 2 (EA score of 1 or 2) and EA >= 3 (EA score of 3, 4, or 5). Results The median Delta CK values in the EA1 to EA5 groups were 3 (quartile -19 similar to 9), 5 (-32 similar to 88), 99.5 (-18 similar to 190.5), 121 (29 similar to 219.5), and 144 (41 similar to 340.5), respectively, indicating a statistically significant difference overall. Statistically significant differences were also observed between the EA1 and EA4 groups and between the EA2 and EA4 groups. The median Delta CK values in the EA <= 2 and EA >= 3 groups were 3 (quartile -27 similar to 85) and 108 (23.5 similar to 206.7), respectively, indicating a statistically significant difference. Conclusion The results of this study revealed that a higher EA score at the time of anesthesia awakening is associated with a larger Delta CK, indicating that a high CK level on the day after surgery is highly related to the state of the patient upon awakening.