Disclosures none Nilsson E, Gasparini A, Arnlov J, Xu H, - - PowerPoint PPT Presentation

To do or not to do?

Pro/Con Debate on

Hyperkalemia for the Elective Cataract Patient

By: Melissa Kreso Associate Professor of Anesthesiology & Perioperative Medicine Ophthalmic Anesthesia Society September 2018

Disclosures

none

Incidence of Hyperkalemia?

• Nilsson E, Gasparini A,

Arnlov J, Xu H, Henriksson KM, Coresh J, Grams ME, Carrero JJ. Incidence and determinants of hyperkalemia and hypokalemia in a large healthcare system. Int J

• f Card 2017; 245:277-

84.

Incidence of Hyperkalemia?

• Nilsson E, Gasparini A,

Arnlov J, Xu H, Henriksson KM, Coresh J, Grams ME, Carrero JJ. Incidence and determinants of hyperkalemia and hypokalemia in a large healthcare system. Int J

• f Card 2017; 245:277-

84.

365,955 people

Incidence of Hyperkalemia?

• Nilsson E, Gasparini A,

Arnlov J, Xu H, Henriksson KM, Coresh J, Grams ME, Carrero JJ. Incidence and determinants of hyperkalemia and hypokalemia in a large healthcare system. Int J

• f Card 2017; 245:277-

84.

Number of People K+ wnl K+ >5.0 mmol/L

Incidence of Hyperkalemia?

• Nilsson E, Gasparini A,

Arnlov J, Xu H, Henriksson KM, Coresh J, Grams ME, Carrero JJ. Incidence and determinants of hyperkalemia and hypokalemia in a large healthcare system. Int J

• f Card 2017; 245:277-

84.

Number of People K+ wnl K+>5.0mmol/L K+ >5.5 mmol/L

Factors for having hyperkalemia

• Nilsson E, Gasparini A,

Arnlov J, Xu H, Henriksson KM, Coresh J, Grams ME, Carrero JJ. Incidence and determinants of hyperkalemia and hypokalemia in a large healthcare system. Int J of Card 2017; 245:277-84.

Factors for having hyperkalemia

• Nilsson E, Gasparini A,

Arnlov J, Xu H, Henriksson KM, Coresh J, Grams ME, Carrero JJ. Incidence and determinants of hyperkalemia and hypokalemia in a large healthcare system. Int J of Card 2017; 245:277-84.

What does this mean for outcomes?

What does these mean on

• utcomes?

The influence of potassium disorders especially hyperkalemia on outcomes has not been established

Potassium & Arrhythmias

Intraoperative dysrhythmias correlated with preoperative dysrhythmias If present, there was a higher incidence intraop But NOT correlated to HIGH potassium levels

Vitez TS, Soper LE, Wong KC, Soper P. Chronic hypokalemia and Intraoperative

• Dysrhythmias. Anesthesiology 1985; 63:

130-3.

Absence of adverse

• utcomes?
• Olson RP, Schow AJ,

McCann R, Lubarsky DA, Gan TJ. Absence of adverse outcomes in hyperkalemic patients undergoing vascular access surgery. Can J Anesth 2003; 50(6): 553-7.

Absence of adverse

• utcomes?
• Olson RP, Schow AJ,

McCann R, Lubarsky DA, Gan TJ. Absence of adverse outcomes in hyperkalemic patients undergoing vascular access surgery. Can J Anesth 2003; 50(6): 553-7.

Absence of adverse

• utcomes?
• Olson RP, Schow AJ,

McCann R, Lubarsky DA, Gan TJ. Absence of adverse outcomes in hyperkalemic patients undergoing vascular access surgery. Can J Anesth 2003; 50(6): 553-7.

People going for vascular surgery

potassium <5 mmol/L potassium>5 mmol/L

People going for vascular surgery

potassium <5 mmol/L potassium>5 mmol/L

Absence of adverse

• utcomes?
• Olson RP, Schow AJ,

McCann R, Lubarsky DA, Gan TJ. Absence of adverse outcomes in hyperkalemic patients undergoing vascular access surgery. Can J Anesth 2003; 50(6): 553-7.

Absence of adverse

• utcomes?
• Olson RP, Schow AJ,

McCann R, Lubarsky DA, Gan TJ. Absence of adverse outcomes in hyperkalemic patients undergoing vascular access surgery. Can J Anesth 2003; 50(6): 553-7.

No Adverse Outcomes!

Risk of serious arrhythmias

Hirsch IA, Tomlinson DL, et al. The overstated risk of preoperative hypokalemia. Anesth Analg 1988; 67(2):131-6.

Risk of serious arrhythmias

• Cardiac/Vascular surgery
• Associated with
• Hx of CHF
• Ventricular aneurysm
• Digoxin usage

Hirsch IA, Tomlinson DL, et al. The overstated risk of preoperative hypokalemia. Anesth Analg 1988; 67(2):131-6.

Risk of serious arrhythmias

• Cardiac/Vascular surgery
• Associated with
• Hx of CHF
• Ventribular aneurysm
• Digoxin usage
• BUT NOT
• Potassium nor

diuretic usage

Hirsch IA, Tomlinson DL, et al. The overstated risk of preoperative hypokalemia. Anesth Analg 1988; 67(2):131-6.

Another study

• Retrospective review
• 1861 patients with CRF

for 8456 surgeries

• 13 (2%) had potassiums >

6.0 mEq/L immediately prior to surgery

• 17 had potassiums

>6.5mEq/L within 6M of having surgery (which were not repeated)

• Underwent planned
• perations
• No difference in adverse

events amongst patients

Ehrenfeld JM, Sedykh A, Furman W,. Management of Potassium abnormalities on the day of Surgery: A Retrospective Review. (A1652) Abstract presented at ASA Annual Meeting; 2011 Chicago, IL

Does ROC rock?

• 61 patient
• Sux group vs rocuronium-

suggamadex group

• Median time
• 406 seconds to spon vent,

sux group

• 216 seconds to spon vent,

roc-sugga group

• Median time TOF 90

recovery

• 518s with sux
• 168s with roc-suga

Sorensen MK, Bretlau C, Gatke MR, Sorensen AM, Rasmussen LS. Rapid sequence induction and intubation with rocuronium-sugammadex compared with succinylcholine: a randomized

• trial. BJA 2012; 108(4): 682-9

Does ROC rock?

Sorensen MK, Bretlau C, Gatke MR, Sorensen AM, Rasmussen LS. Rapid sequence induction and intubation with rocuronium- sugammadex compared with succinylcholine: a randomized trial. BJA 2012; 108(4): 682-9

Does ROC rock?

• Rapid sequence induction

with rocuronium f/b sugammadex = earlier re- establishment of spontaneous ventilation than with succinylcholine alone!

Sorensen MK, Bretlau C, Gatke MR, Sorensen AM, Rasmussen LS. Rapid sequence induction and intubation with rocuronium-sugammadex compared with succinylcholine: a randomized trial. BJA 2012; 108(4): 682-9