Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2024 Nov 22;16(11):e74272.
doi: 10.7759/cureus.74272. eCollection 2024 Nov.

Effect of Regional Anesthesia on Intraoperative Hyperkalemia in Patients With Chronic Kidney Disease: Two Case Reports

Shunsuke Oura  1 , Marie Okada  2 , Ryo Miyashita  2
Affiliations
Case Reports

Effect of Regional Anesthesia on Intraoperative Hyperkalemia in Patients With Chronic Kidney Disease: Two Case Reports

Shunsuke Oura et al. Cureus. .

Abstract

Intraoperative hyperkalemia is particularly common in patients with chronic kidney disease (CKD). We report two cases of intraoperative hyperkalemia occurring under general anesthesia, while potassium levels remained stable with regional anesthesia alone. Case 1 involved a 69-year-old male with CKD who underwent total thyroidectomy under general anesthesia and developed intraoperative hyperkalemia, requiring glucose-insulin (GI) therapy. The same patient, however, maintained stable potassium levels during transurethral resection of a bladder tumor performed with spinal anesthesia. Case 2 involved a 72-year-old male with rheumatoid arthritis who underwent artificial joint replacement and tendon transplantation of his finger under a combination of general and regional anesthesia. He developed intraoperative hyperkalemia requiring GI, but stable potassium levels were maintained during bilateral total knee arthroplasty under epidural and spinal anesthesia. Our cases highlight the potential of regional anesthesia to reduce the risk of intraoperative hyperkalemia, particularly in patients with CKD.

Keywords: acute kidney injury; chronic kidney disease; general anesthesia; hyperkalemia; regional anesthesia.

PubMed Disclaimer

Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

References

    1. The frequency of hyperkalemia and its significance in chronic kidney disease. Einhorn LM, Zhan M, Hsu VD, et al. Arch Intern Med. 2009;169:1156–1162. - PMC - PubMed
    1. Anesthesia and the renal sympathetic nervous system in perioperative AKI. Franzén S, DiBona G, Frithiof R. Semin Nephrol. 2022;42:151283. - PubMed
    1. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. Rodgers A, Walker N, Schug S, et al. BMJ. 2000;321:1493. - PMC - PubMed
    1. Epidural analgesia improves outcome in cardiac surgery: a meta-analysis of randomized controlled trials. Bignami E, Landoni G, Biondi-Zoccai GG, et al. J Cardiothorac Vasc Anesth. 2010;24:586–597. - PubMed
    1. Combined general and neuraxial anesthesia versus general anesthesia: a population-based cohort study. Nash DM, Mustafa RA, McArthur E, et al. Can J Anaesth. 2015;62:356–368. - PubMed

Publication types

LinkOut - more resources