Evidence-based perioperative management of patients with high serum potassium level in resource-limited areas: A systematic review

Abstract

This systematic review was conducted according to the Preferred Reporting Items for Systematic review and meta-analysis (PRISMA) protocol. Search engines like PubMed through HINARI, Cochrane database, GoogleScholar and ScienceDirect were used to find high-level evidence that helps to draw appropriate conclusions. Potassium is a critical electrolyte for cellular functions and its serum concentration must be precisely maintained between 3.5 and 5.5 mEq/L. A multidisciplinary approach is crucial to identify and optimise high risk surgical patients prone to hyperkalemia during preoperative assessment. Elective surgery should be deferred in patients with serum potassium level >6 mEq/L during and appropriate management should be initiated. Given the variable presentation of hyperkalemia, clinicians should have high index of suspicion of potassium disorders among patients with chronic kidney disease, poorly controlled diabetes mellitus, burns, recent major trauma and blood transfusion. In high risk surgical patients with a normal range of serum potassium level drugs like suxamethonium and Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided. Goal direct fluid regimes with 0.9% normal saline, a high threshold for blood transfusion and tight glycemic controlled are recommended. IV calcium gluconate, insulin -dextrose regime and diuretics are the main therapeutic options in patients with severe hyperkalemia. Highlights:

Severe Hyperkalemia During a Robot-Assisted Total Radical Prostatectomy in a Patient with Stage 3a Chronic Kidney Disease: A Case Report

“…Some suggest postponing surgery in patients with preoperative potassium concentration >6 mmol/L. 10 In our patient's case, the preoperative potassium concentration was only determined to be >6 mmol/L the day before surgery. Other results on the day of surgery indicated…”

Profound Hyperkalemia and Anemia in a Dialysis Patient With a Gastrointestinal Bleed

“…Beta-adrenergic receptor blockers (e.g., metoprolol), potassium-sparing diuretics (e.g., spironolactone), metabolic acidosis, ischemic necrosis, hemolysis, rhabdomyolysis, and severe hyperglycemia have all been found to increase serum potassium as well. While it is not always possible to avoid these medications and situations, it is essential to do whenever clinically feasible to lower the likelihood of inducing significant hyperkalemia in susceptible patients [ 9 ].…”

Preoperative Investigations: Practice Guidelines from the Indian Society of Anaesthesiologists

“…Alterations in serum sodium and serum potassium may be associated with medical and surgical disorders, drug intake and have a potential to affect the anaesthetic management and the outcomes. [ 34 35 36 37 ] One study involving intermediate surgeries (n = 20915),[ 20 ] and two studies involving minor and intermediate surgeries (n = 765) did not report any adverse outcomes related to deranged serum electrolytes. [ 21 23 ] Three studies involving all three categories of surgeries (n = 608), showed influence on outcomes in five patients with deranged serum sodium.…”