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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


  1. 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

  2. Disclosures none

  3. • 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. Incidence of Hyperkalemia?

  4. 365,955 • Nilsson E, Gasparini A, Arnlov J, Xu H, Henriksson people 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. Incidence of Hyperkalemia?

  5. Number of People • 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 K+ wnl K+ >5.0 mmol/L of Card 2017; 245:277- 84. Incidence of Hyperkalemia?

  6. Number of People • Nilsson E, Gasparini A, Arnlov J, Xu H, Henriksson KM, Coresh J, Grams ME, Carrero JJ. Incidence and determinants of hyperkalemia and K+ wnl K+>5.0mmol/L hypokalemia in a large healthcare system. Int J K+ >5.5 mmol/L of Card 2017; 245:277- 84. Incidence of Hyperkalemia?

  7. • 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

  8. • 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

  9. What does this mean for outcomes?

  10. What does these mean on outcomes? The influence of potassium disorders especially hyperkalemia on outcomes has not been established

  11. Potassium & Intraoperative dysrhythmias correlated with preoperative dysrhythmias Arrhythmias 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.

  12. Absence of adverse outcomes? • 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.

  13. Absence of adverse outcomes? • 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.

  14. People going for vascular Absence of surgery adverse outcomes? • 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. potassium <5 mmol/L potassium>5 mmol/L

  15. People going for vascular Absence of surgery adverse outcomes? • 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. potassium <5 mmol/L potassium>5 mmol/L

  16. Absence of adverse outcomes? No • Olson RP, Schow AJ, Adverse McCann R, Lubarsky DA, Gan TJ. Absence of adverse outcomes in Outcomes! hyperkalemic patients undergoing vascular access surgery. Can J Anesth 2003; 50(6): 553-7.

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

  18. Risk of serious • Cardiac/Vascular surgery arrhythmias • 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.

  19. • Cardiac/Vascular surgery Risk of • Associated with • Hx of CHF serious • Ventribular aneurysm • Digoxin usage arrhythmias • BUT NOT • Potassium nor Hirsch IA, Tomlinson DL, et al. The overstated diuretic usage risk of preoperative hypokalemia. Anesth Analg 1988; 67(2):131-6.

  20. • Retrospective review • 1861 patients with CRF Another for 8456 surgeries • 13 (2%) had potassiums > study 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 operations • No difference in adverse Ehrenfeld JM, Sedykh A, Furman W,. events amongst patients Management of Potassium abnormalities on the day of Surgery: A Retrospective Review. (A1652) Abstract presented at ASA Annual Meeting; 2011 Chicago, IL

  21. • 61 patient Does ROC • Sux group vs rocuronium- suggamadex group • Median time rock? • 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

  22. 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

  23. Does ROC • Rapid sequence induction rock? 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

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