Abstract
Children undergoing major craniofacial surgery (MCFS) often require transfusion in excess of one blood volume. Therefore they were the subject of a retrospective review which looked at the longitudinal trend of plasma potassium concentration [K+] during surgery. Ten of eleven children had a statistically significant increase in plasma potassium concentration during their intraoperative course and in five the potassium concentration exceeded 5.5 mmol · L−1. This was in contrast to the stable intraoperative plasma [K+] observed in a control group which did not receive blood transfusion. All MCFS children received a blood transfusion with red blood cell concentrates (RBCconc). The age of the units of RBCconc which had been transfused was 16.1 ± 8.4 days. The amount of extracellular potassium in 28 units of RBCconc was determined in order to estimate the amount of free potassium (Kdose) which the MCFS group received. The plasma [K+] in units of RBCconc < 1 week of age was < 20 mmol · L−1, whereas in units aged > 2 weeks it was > 40 mmol · L−1. The estimated Kdose was 0.2–1.6 mmol · kg−1. We concluded that the amount of extracellular potassium in units of RBCconc was clinically important and may give rise to hyperkalaemia during massive blood transfusion.
Résumé
Il faut souvent transfuser massivement les enfants subissant une reconstruction crâniofaciale majeure. Nous avons revu le profil kaliémique intra-opératoire de onze d’entre eux. Chez dix, la kaliémie augmentail de façon statistiquement significative pendant l’intervention et chez cinq, elle dépassait 5,5 mmol · L−1 alors que la kaliémie intra-opératoire demeurait stable chez les enfants non transfusés d’un groupe contrôle. Lors des reconstructions, tous les enfants avaient été transfusés avec des culots globulaires récoltés en moyenne 16,1 ± 8,4 jours auparavant. Nous avons mesuré la concentration plasmatique de potassium de 28 culots globulaires et avons trouvé qu’elle était inférieure à 20 mmol · L−1 dans les culots récoltés moins d’une semaine plus tôt et de plus de 40 mmol · L−1 dans ceux de deux semaines et plus. Nous avons ainsi pu estimer que les enfants avaient reçu entre 0,2 et 1,6 mmol · kg−1 de potassium. Les culots globulaires contiennent donc une quantité appréciable de potassium, susceptible d’amener de l’hyperkaliémie lors de transfusions massives.
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Brown, K.A., Bissonnette, B., MacDonald, M. et al. Hyperkalaemia during massive blood transfusion in paediatric craniofacial surgery. Can J Anaesth 37, 401–408 (1990). https://doi.org/10.1007/BF03005615
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DOI: https://doi.org/10.1007/BF03005615