Acute respiratory acidosis does not increase plasma potassium in normokalaemic anaesthetized patients. A controlled randomized trial

Natalini, Giuseppe; Seramondi, V.; Fassini, Paola; Foccoli, Pierfranco; Toninelli, Carlo; Cavaliere, Sergio; Candiani, A

doi:10.1046/j.1365-2346.2001.00863.x

Cited by 9 publications

(11 citation statements)

References 16 publications

(35 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While a linear correlation between arterial carbon dioxide and plasma pH is well reported,39 the relationship between acute hypercapnia, respiratory acidosis and plasma potassium is also poorly understood 40. In the present study, we found no association between hypercapnia and serum potassium concentration, a finding also supported by others 41. We did not observe any other deleterious or adverse effects from hypercapnic-induced acidosis such as cardiac arrhythmias in our study.…”

Section: Discussionsupporting

confidence: 84%

Randomised controlled trial to investigate the relationship between mild hypercapnia and cerebral oxygen saturation in patients undergoing major surgery

et al. 2020

View full text Add to dashboard Cite

ObjectivesThe effects of hypercapnia on regional cerebral oxygen saturation (rSO2) during surgery are unclear. We conducted a randomised controlled trial to investigate the relationship between mild hypercapnia and rSO2. We hypothesised that, compared with targeted normocapnia (TN), targeted mild hypercapnia (TMH) during major surgery would increase rSO2.DesignA prospective, randomised, controlled trial in adult participants undergoing elective major surgery.SettingA single tertiary centre in Heidelberg, Victoria, Australia.Participants40 participants were randomised to either a TMH or TN group (20 to each).InterventionsTMH (partial pressure of carbon dioxide in arterial blood, PaCO2, 45–55 mm Hg) or TN (PaCO235–40 mm Hg) was delivered via controlled ventilation throughout surgery.Primary and secondary outcome measuresThe primary endpoint was the absolute difference between the two groups in percentage change in rSO2from baseline to completion of surgery. Secondary endpoints included intraoperative pH, bicarbonate concentration, base excess, serum potassium concentration, incidence of postoperative delirium and length of stay (LOS) in hospital.ResultsThe absolute difference between the two groups in percentage change in rSO2from the baseline to the completion of surgery was 19.0% higher in both hemispheres with TMH (p<0.001). On both sides, the percentage change in rSO2was greater in the TMH group than the TN group throughout the duration of surgery. The difference between the groups became more noticeable over time. Furthermore, postoperative delirium was higher in the TN group (risk difference 0.3, 95% CI 0.1 to 0.5, p=0.02). LOS was similar between groups (5 days vs 5 days; p=0.99).ConclusionTMH was associated with a stable increase in rSO2from the baseline, while TN was associated with a decrease in rSO2in both hemispheres in patients undergoing major surgery. This resulted in a clear separation of percentage change in rSO2from the baseline between TMH and TN over time. Our findings provide the rationale for larger studies on TMH during surgery.Trial registration numberThe Australian New Zealand Clinical Trials Registry (ACTRN12616000320459).

show abstract

Section: Discussionsupporting

confidence: 84%

Randomised controlled trial to investigate the relationship between mild hypercapnia and cerebral oxygen saturation in patients undergoing major surgery

et al. 2020

View full text Add to dashboard Cite

show abstract

“…A more recent prospective randomised controlled trial by Natalini et al[8] examined plasma potassium in 17 normokalaemic anaesthetised patients who underwent either spontaneous-assisted ventilation or intermittent negative-pressure ventilation during interventional rigid bronchoscopy. Similar to our findings, the authors observed no association between increased extracellular H + and plasma potassium concentrations.…”

Section: Discussionmentioning

confidence: 99%

“…However, our study differed in regard to surgical and anaesthetic procedures, patient populations and analysis. In particular, patients with coronary artery disease were specifically excluded in the Natalini et al[8] study, which is an important comorbidity in modern anaesthetic practice. In addition, only the relationship between potassium and H+ was discussed in the Natalini et al[8] paper, whereas our study also looked at the influence of PaCO 2 on potassium.…”

Section: Discussionmentioning

confidence: 99%

Relationship between acute hypercarbia and hyperkalaemia during surgery

Weinberg¹,

Russell²,

Mackley³

et al. 2019

WJCC

View full text Add to dashboard Cite

BACKGROUNDThe relationship between hyperkalaemia and metabolic acidosis is well described in the critical care setting; however, the relationship between acute respiratory acidosis and plasma potassium concentration is less well understood. In a controlled model of increasing levels of hypercarbia, we tested the hypothesis of whether increasing levels of hypercarbia are associated with changes in plasma potassium concentrations.AIMTo determine whether increasing levels of hypercarbia are associated with changes in plasma potassium concentrations.METHODSWe performed a post-hoc study examining changes in serum potassium in 24 patients who received increased levels of hypercarbia during cardiac surgery. Arterial blood gases and plasma concentrations of potassium were measured at baseline, 3 min prior to, and then every 3 min for 15 min during the intervention of hypercarbia. The primary endpoint was the absolute change in serum K+ at 15 min compared to the baseline K+ value. The following secondary endpoints were evaluated: (1) The association between CO2 and serum K+ concentration; and (2) The correlation between plasma pH and serum K+ concentrations.RESULTSDuring the intervention, PaCO2 increased from 43.6 mmHg (95%CI: 40.1 to 47.1) at pre-intervention to 83.9 mmHg (95%CI: 78.0 to 89.8) at 15 min after intervention; P < 0.0001. The mean (SD) serum potassium increased from 4.16 (0.35) mmol/L at baseline to 4.28 (0.33) mmol/L at 15 min (effect size 0.09 mol/L; P = 0.22). There was no significant correlation between PaCO2 and potassium (Pearson’s coefficient 0.06; 95%CI: -0.09 to 0.21) or between pH and potassium (Pearson’s coefficient -0.07; 95%CI: -0.22 to 0.09).CONCLUSIONAcute hypercarbia and subsequent respiratory acidaemia were not associated with hyperkalaemia in patients undergoing major surgery.

show abstract

“…This study was limited by a small sample size and exposure to significant hypercarbia for only a 15 min duration. Similarly, Natalani et al [10] compared the acute changes in [K + ] p in acutely hypercapnic patients undergoing rigid bronchoscopy. The sampling time to evaluate the effects of PaCO 2 on hyperkalaemia was also of short duration (20 min), and acute respiratory acidosis did not affect [K + ] p .…”

Section: Discussionmentioning

confidence: 99%

“…potassium concentrations ([K + ] p ) is unclear with some studies showing an increase in concentration and others showing no effect [3][4][5][6][7][8][9][10]. Further, a body of longstanding evidence indicates that the hyperkalaemia-acidaemia relationship is more complex than the relatively simplistic, but commonly accepted notion that hyperkalaemia develops due to an increase in extracellular acidity and subsequent exchange of extracellular hydrogen ions for intracellular potassium ions [8].…”

mentioning

confidence: 99%

The association of acute hypercarbia and plasma potassium concentration during laparoscopic surgery: a retrospective observational study

et al. 2021

View full text Add to dashboard Cite

Background It is uncertain whether increases in PaCO2 during surgery lead to an increase in plasma potassium concentration and, if so, by how much. Hyperkalaemia may result in cardiac arrhythmias, muscle weakness or paralysis. The key objectives were to determine whether increases in PaCO2 during laparoscopic surgery induce increases in plasma potassium concentrations and, if so, to determine the magnitude of such changes. Methods A retrospective observational study of adult patients undergoing laparoscopic abdominal surgery was perfomed. The independent association between increases in PaCO2 and changes in plasma potassium concentration was assessed by performing arterial blood gases within 15 min of induction of anaesthesia and within 15 min of completion of surgery. Results 289 patients were studied (mean age of 63.2 years; 176 [60.9%] male, and mean body mass index of 29.3 kg/m2). At the completion of the surgery, PaCO2 had increased by 5.18 mmHg (95% CI 4.27 mmHg to 6.09 mmHg) compared to baseline values (P < 0.001) with an associated increase in potassium concentration of 0.25 mmol/L (95% CI 0.20 mmol/L to 0.31 mmol/L, P < 0.001). On multiple regression analysis, PaCO2 changes significantly predicted immediate changes in plasma potassium concentration and could account for 33.1% of the variance (r2 = 0.331, f(3,259) = 38.915, P < 0.001). For each 10 mmHg increment of PaCO2 the plasma potassium concentration increased by 0.18 mmol/L. Conclusion In patients receiving laparoscopic abdominal surgery, there is an increase in PaCO2 at the end of surgery, which is independently associated with an increase in plasma potassium concentration. However, this effect is small and is mostly influenced by intravenous fluid therapy (Plasma-Lyte 148 solution) and the presence of diabetes. Trial registration Retrospectively registered in the Australian New Zealand Clinical Trials Registry (Trial Number: ACTRN12619000716167).

show abstract

Acute respiratory acidosis does not increase plasma potassium in normokalaemic anaesthetized patients. A controlled randomized trial

Abstract: Acute respiratory acidosis does not affect plasma potassium concentration.

Cited by 9 publications

References 16 publications

Randomised controlled trial to investigate the relationship between mild hypercapnia and cerebral oxygen saturation in patients undergoing major surgery

Randomised controlled trial to investigate the relationship between mild hypercapnia and cerebral oxygen saturation in patients undergoing major surgery

Relationship between acute hypercarbia and hyperkalaemia during surgery

The association of acute hypercarbia and plasma potassium concentration during laparoscopic surgery: a retrospective observational study

Contact Info

Product

Resources

About