Absence of adverse outcomes in hyperkalemic patients undergoing vascular access surgery

Abstract

P Pu ur rp po os se e: : 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.M Me et th ho od ds s: : 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 retrospectively.R Re es su ul lt ts s: : 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.C Co on nc cl lu us si io on n: : 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. IGNIFICANT preoperative hyperkalemia is considered a contraindication to anesthesia. Objectif : La décision d'annuler une opération d'accès1-3 Retrospective studies have detected an association between hyperkalemia and increased mortality in hospitalized patients, 4-6 and surgical patients, 7-9 but reports of perioperative morbidity directly attributable to hyperkalemia are actually quite rare. 4,5,[8][9][10] Patients with renal failure scheduled for vascular access surgery present a dilemma. Long-term potassium (K) homeostasis is dependent on vascular access for dialysis, yet the surgery to construct this access may be delayed if the patient is hyperkalemic. The National Kidney Foundation recommends that a vascular access fistula or graft be placed well before the need for dialysis.11 Because these accesses are superior to catheters, 11 delaying this type of surgery in renal failure patients because of hyperkalemia may be counterproductive. The decision to delay because of hyperkalemia requires some knowledge of the hazards associated with proceeding to surgery in the presence of hyperkalemia.

Patient Selection for Adult Ambulatory Surgery: A Narrative Review

“…Of note, asymptomatic hyperkalemia may not be an absolute contraindication to vascular access surgery. 106…”

“…Of note, asymptomatic hyperkalemia may not be an absolute contraindication to vascular access surgery. 106 Previous studies have demonstrated the safety of arteriovenous fistula (AVF) creation surgery in the outpatient setting, particularly when performed under local or regional anesthesia. [107][108][109] A recent comparison of postoperative complications after AVF surgery in the inpatient and outpatient setting showed a significantly lower rate of admissions and total hospital visits within 7 days for outpatient AVF creation.…”

Impact of Hyperkalemia on Surgery Case Cancellation: A Call For Increased Reliability

“…Significant elevations of serum potassium can have an adverse impact on the reliability and quality of surgical patient care as well as on patient experience when hyperkalemia is encountered perioperatively; consequently, anesthesiologists, surgeons, and the entire healthcare team need to have strategies to effectively manage HK to ensure optimal patient outcomes. Although there are isolated reports of safely operating on patients with HK, they are typically restricted to patients with chronic renal failure undergoing a vascular access procedure under regional anesthesia [2]. The most robust data regarding the risk of HK is published with respect to hospitalized patients in general, and the relationship between HK and increased morbidity and mortality is well established [12][13][14][15][16][17].…”

“…urgent or emergent hemodialysis, and cancellation or delay of elective surgeries and procedures [1][2][3]. Hyperkalemia is typically asymptomatic but is known to increase the risk of potentially fatal cardiac irritability.…”