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The effect of patient-controlled intravenous analgesia on postoperative hypokalemia in patients undergoing laparoscopic cholecystectomy

Journal of Anesthesia volume 25, Article number: 685 (2011) Cite this article

Abstract

Purpose

We investigated whether hypokalemia developed during the postoperative period and whether the use of intravenous patient-controlled analgesia (IV-PCA) could decrease the incidence of postoperative hypokalemia in patients who underwent laparoscopic cholecystectomy.

Methods

Sixty patients undergoing laparoscopic cholecystectomy were randomly assigned to either IV-PCA (n = 30) or control (n = 30) groups. We measured serum potassium concentration at the outpatient department (T1), at 8:00 a.m. on the day of surgery (T2), at 6 h after the end of surgery (T3), and at 8:00 a.m. on the first (T4), second (T5), and third (T6) postoperative days. Serum potassium concentration, incidence of hypokalemia, mean blood pressure, heart rate, respiratory rate, and the patient-reported visual analogue scale score were compared within each group and between groups at each time point.

Results

Serum potassium concentrations in all patients showed a significant decrease at T2–T4 compared to the preoperative concentration (T1). Serum potassium concentrations at T3 and T4 in the IV-PCA group were significantly higher than those in the control group. Also, the incidence of hypokalemia at T3 and T4 was significantly lower in the IV-PCA group. Mean blood pressure and heart rate were significantly lower in the IV-PCA group than in controls at T3 and T4.

Conclusions

The results show that hypokalemia developed during the perioperative period and the use of IV-PCA in patients undergoing laparoscopic cholecystectomy effectively decreased the degree and incidence of postoperative hypokalemia on the day of the operation and postoperative day one.

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References

  1. Surawicz B. The interrelationship of electrolyte abnormalities and arrhythmias. In: Mandel WJ, editor. Cardiac arrhythmias: their mechanisms, diagnosis, and management. Philadelphia: JB Lippincott; 1985. p. 89–110.

    Google Scholar 

  2. Hulting J. In-hospital ventricular fibrillation and its relation to serum potassium. Acta Med Scand Suppl. 1981;647:109–16.

    PubMed  CAS  Google Scholar 

  3. Grumbach L, Howard JW, Merrill VI. Factors related to the initiation of ventricular fibrillation in the isolated heart: effect of calcium and potassium. Circ Res. 1954;2:452–9.

    PubMed  CAS  Google Scholar 

  4. Fisch C, Knoebel SB, Feigenbaum H, Greenspan K. Potassium and the monophasic action potential, electrocardiogram, conduction and arrhythmia. Prog Cardiovasc Dis. 1966;8:387–418.

    PubMed  Article  CAS  Google Scholar 

  5. Gettes L, Surawicz B. Effects of low and high concentration of potassium on the simultaneously recorded Purkinje and ventricular action potentials of the perfused pig moderator band. Circ Res. 1968;23:717–29.

    PubMed  CAS  Google Scholar 

  6. Wahr JA, Parks R, Boisvert D, Comunale M, Fabian J, Ramsay J, Mangano DT. Preoperative serum potassium levels and perioperative outcomes in cardiac surgery patients. JAMA. 1999;281:2203–10.

    PubMed  Article  CAS  Google Scholar 

  7. Yano K, Matsumoto Y, Hirata M, Hirata T, Hano O, Mitsuoka T, Hashiba K. Influence of sympathetic nerve activity on ventricular arrhythmogenicity in the dog with chronic hypokalemia. Angiology. 1991;42:878–88.

    PubMed  Article  CAS  Google Scholar 

  8. Obeid AI, Verrier RL, Lown B. Influence of glucose, insulin and potassium on vulnerability to ventricular fibrillation in the canine heart. Circ Res. 1978;43:601–8.

    PubMed  CAS  Google Scholar 

  9. Tetzlaff JE, O’Hara JF Jr, Walsh MT. Potassium and anaesthesia. Can J Anaesth. 1993;40:227–46.

    PubMed  Article  CAS  Google Scholar 

  10. Wong KC. Hypokalemia and dysrhythmias. J Cardiothorac Anesth. 1989;3:529–31.

    PubMed  Article  CAS  Google Scholar 

  11. Hahm TS, Cho HS, Lee KH, Chung IS, Kim JA, Kim MH. Clonidine premedication prevents preoperative hypokalemia. J Clin Anesth. 2002;14:6–9.

    PubMed  Article  CAS  Google Scholar 

  12. Cho HS, Lee SM, Lee JJ, Jung IS, Kim YH, Choi DH, Shin BS. Prevention of hypokalemia before induction of anesthesia by clonidine or midazolam. Korean J Anesthesiol. 1998;34:920–4.

    Google Scholar 

  13. McCleane GJ, Watters CH. Pre-operative anxiety and serum potassium. Anaesthesia. 1990;45:583–5.

    PubMed  Article  CAS  Google Scholar 

  14. Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, Dallongeville J, De Backer G, Ebrahim S, Gjelsvik B, Herrmann-Lingen C, Hoes A, Humphries S, Knapton M, Perk J, Priori SG, Pyorala K, Reiner Z, Ruilope L, Sans-Menendez S, Scholte op Reimer W, Weissberg P, Wood D, Yarnell J, Zamorano JL, Walma E, Fitzgerald T, Cooney MT, Dudina A, European Society of Cardiology (ESC) Committee for Practice Guidelines (CPG). European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Eur Heart J. 2007;28:2375–414.

    PubMed  Article  Google Scholar 

  15. Karasch ED, Bowdle TA. Hypokalemia before induction of anesthesia and prevention by β2-adrenoceptor antagonism. Anesth Analg. 1991;72:216–20.

    Article  Google Scholar 

  16. Massara F, Tripodina A, Rotunno M. Propranolol block of epinephrine-induced hypokalaemia in man. Eur J Pharmacol. 1970;10:404–7.

    PubMed  Article  CAS  Google Scholar 

  17. Tran CT, Schmidt TA, Christensen JB, Kjeldsen K. Atrial Na, K-ATPase increase and potassium dysregulation accentuate the risk of postoperative atrial fibrillation. Cardiology. 2009;114:1–7.

    PubMed  Article  CAS  Google Scholar 

  18. Dabar D, Smith M, Morike K, Roden DM. Epinephrine-induced changes in serum potassium and cardiac repolarization and effects of pretreatment with propranolol and diltiazem. Am J Cardiol. 1996;77:1351–5.

    Article  Google Scholar 

  19. Brown MJ, Brown DC, Murphy MB. Hypokalemia from β2-receptor stimulation by circulating epinephrine. N Engl J Med. 1983;309:1414–9.

    PubMed  Article  CAS  Google Scholar 

  20. Adams HA, Saatweber P, Schmitz CS, Hecker H. Postoperative pain management in orthopaedic patients: no differences in pain score, but improved stress control by epidural anaesthesia. Eur J Anaesthesiol. 2002;19:658–65.

    PubMed  CAS  Google Scholar 

  21. Siscovick DS, Raghunathan TE, Psaty BM, Koepsell TD, Wicklund KG, Lin X, Cobb L, Rautaharju PM, Copass MK, Wagner EH. Diuretic therapy for hypotension and the risk of primary cardiac arrest. N Engl J Med. 1994;330:1852–7.

    PubMed  Article  CAS  Google Scholar 

  22. Shah KB, Keinman BS, Rao RL, Jacobs HK, Mestan K, Schaafsma M. Angina and other risk factors in patients with cardiac diseases undergoing noncardiac operations. Anesth Analg. 1990;70:240–7.

    PubMed  Article  CAS  Google Scholar 

  23. Hirsch IA, Tomlinson DL, Slogoff S, Keats AS. The overstated risk of preoperative hypokalemia. Anesth Analg. 1988;67:131–6.

    PubMed  Article  CAS  Google Scholar 

  24. Vitez TS, Sopper LE, Wong KC, Soper P. Chronic hypokalemia and intraoperative dysrhythmias. Anesthesiology. 1985;63:130–3.

    PubMed  Article  CAS  Google Scholar 

  25. McGovern B. Hypokalemia and cardiac arrhythmias. Anesthesiology. 1985;63:127–9.

    PubMed  Article  CAS  Google Scholar 

  26. Watt JW, Silva P. Respiratory alkalosis and associated electrolytes in long-term ventilator dependent persons with tetraplegia. Spinal Cord. 2001;39:557–63.

    PubMed  Article  CAS  Google Scholar 

  27. Krapf R. Acid-base and potassium homeostasis. Nephrol Dial Transplant. 1995;10:1537–9.

    PubMed  CAS  Google Scholar 

  28. Muir WW 3rd, Wagner AE, Buchanan C. Effects of acute hyperventilation on serum potassium in the dog. Vet Surg. 1990;19:83–7.

    PubMed  Article  Google Scholar 

  29. Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000;85:109–17.

    PubMed  Article  CAS  Google Scholar 

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Affiliations

  1. Department of Anesthesiology and Pain Medicine, Samsung Seoul Hospital, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Kangnam-Gu, Seoul, 135-710, Republic of Korea

    Won Ho Kim, Jong Hwan Lee, Justin Sangwook Ko, Tae Soo Hahm, Sangmin M. Lee & Hyun Sung Cho

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  1. Won Ho Kim
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  2. Jong Hwan Lee
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  3. Justin Sangwook Ko
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  4. Tae Soo Hahm
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  5. Sangmin M. Lee
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  6. Hyun Sung Cho
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Correspondence to Hyun Sung Cho.

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Kim, W.H., Lee, J.H., Ko, J.S. et al. The effect of patient-controlled intravenous analgesia on postoperative hypokalemia in patients undergoing laparoscopic cholecystectomy. J Anesth 25, 685 (2011). https://doi.org/10.1007/s00540-011-1208-2

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  • DOI: https://doi.org/10.1007/s00540-011-1208-2

Keywords

  • Patient-controlled intravenous analgesia
  • Hypokalemia
  • Arrhythmia
  • Catecholamine
  • Laparoscopic cholecystectomy