Abstract
Purpose
The decision to cancel vascular access surgery because of hyperkalemia requires knowledge of the risks vs benefits. This study sought to identify and characterize cases where surgery had been performed in patients with uncorrected hyperkalemia.
Methods
One thousand four hundred and seventy-two consecutive cases of vascular access surgery at an academic medical centre between 1995 and 2000 by a single surgeon were analyzed retro-spectively.
Results
Eight cases had clear documentation that the case proceeded with hyperkalemia. Anesthesia techniques were one general anesthetic, one regional block, five monitored anesthesia care (MAC), and one local infiltration only. Mean potassium was 6.9 mmol·L−1 (range 6.1–8.0). In this series of selected asymptomatic hyperkalemic patients undergoing low risk surgery, no adverse results occurred.
Conclusion
While this review of eight cases (only one receiving general anesthesia) cannot be used to prove the safety of proceeding to surgery with uncorrected hyperkalemia, it does suggest that asymptomatic hyperkalemia may not be an absolute contraindication to vascular access surgery.
Résumé
Objectif
La décision d’annuler une opération d’accès vasculaire à cause de l’hyperkaliémie exige de connaître les risques et les avantages. La présente étude visait à identifier et à caractériser les cas où l’opération a été réalisée chez des patients présentant une hyperkaliémie non corrigée.
Méthode
Nous avons fait l’analyse rétrospective des opérations d’accès vasculaires réalisées chez 1 472 patients consécutifs au centre médical universitaire entre 1995 et 2000 par le même chirurgien.
Résultats
Dans huit cas, les données indiquaient clairement que l’opération avait eu lieu malgré l’hyperkaliémie. Les techniques anesthésiques étaient une anesthésie générale, une anesthésie régionale, cinq cas de surveillance anesthésique (SA) et une infiltration locale seulement. La moyenne du potassium était de 6,9 mmol·L−1 (intervalle de 6,1–8,0). Dans cette série de patients hyperkaliémiques asymptomatiques choisis, devant subir une intervention à faible risque, aucune complication n’est survenue.
Conclusion
Même si cette revue de huit cas, dont un seul cas d’anesthésie générale, ne prouve pas la sécurité d’une intervention chirurgicale en présence d’hyperkaliémie non corrigée, elle suggère que l’hyperkaliémie asymptomatique ne serait pas une contre-indication absolue à une opération à accès vasculaire.
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Olson, R.P., Schow, A.J., McCann, R. et al. Absence of adverse outcomes in hyperkalemic patients undergoing vascular access surgery. Can J Anesth 50, 553–557 (2003). https://doi.org/10.1007/BF03018639
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DOI: https://doi.org/10.1007/BF03018639