Abstract
BackgroundIt is uncertain whether increases in PaCO2 during surgery lead to an increase in plasma potassium concentration and, if so, by how much. Hyperkalaemia may result in cardiac arrhythmias, muscle weakness or paralysis. The key objectives were to determine whether increases in PaCO2 during laparoscopic surgery induce increases in plasma potassium concentrations and, if so, to determine the magnitude of such changes.MethodsA retrospective observational study of adult patients undergoing laparoscopic abdominal surgery was perfomed. The independent association between increases in PaCO2 and changes in plasma potassium concentration was assessed by performing arterial blood gases within 15 min of induction of anaesthesia and within 15 min of completion of surgery.Results289 patients were studied (mean age of 63.2 years; 176 [60.9%] male, and mean body mass index of 29.3 kg/m2). At the completion of the surgery, PaCO2 had increased by 5.18 mmHg (95% CI 4.27 mmHg to 6.09 mmHg) compared to baseline values (P < 0.001) with an associated increase in potassium concentration of 0.25 mmol/L (95% CI 0.20 mmol/L to 0.31 mmol/L, P < 0.001). On multiple regression analysis, PaCO2 changes significantly predicted immediate changes in plasma potassium concentration and could account for 33.1% of the variance (r2 = 0.331, f(3,259) = 38.915, P < 0.001). For each 10 mmHg increment of PaCO2 the plasma potassium concentration increased by 0.18 mmol/L.ConclusionIn patients receiving laparoscopic abdominal surgery, there is an increase in PaCO2 at the end of surgery, which is independently associated with an increase in plasma potassium concentration. However, this effect is small and is mostly influenced by intravenous fluid therapy (Plasma-Lyte 148 solution) and the presence of diabetes.Trial registration Retrospectively registered in the Australian New Zealand Clinical Trials Registry (Trial Number: ACTRN12619000716167).
Highlights
It is uncertain whether increases in Partial pressure of arterial carbon dioxide (PaCO2) during surgery lead to an increase in plasma potassium con‐ centration and, if so, by how much
To accurately compare changes in PaCO2 and [Plasma potassium concentrations (K+]p) during surgery to baseline values, data was collected from patients who had an arterial blood gas sampled within 15 min of induction of anaesthesia and a subsequent arterial blood gas sampled within 15 min of completion of surgery
At the completion of the surgery, PaCO2 had increased by 5.18 mmHg (95%Confidence interval (CI), 4.27 mmHg to 6.09 mmHg) compared to baseline values (P < 0.001, Cohen’s d = 1.26,)
Summary
It is uncertain whether increases in PaCO2 during surgery lead to an increase in plasma potassium con‐ centration and, if so, by how much. A body of longstanding evidence indicates that the hyperkalaemia-acidaemia relationship is more complex than the relatively simplistic, but commonly accepted notion that hyperkalaemia develops due to an increase in extracellular acidity and subsequent exchange of extracellular hydrogen ions for intracellular potassium ions [8]. Challenging this theory, early studies have shown that the directional flux of potassium during acute acid–base disorders is not uniform among various tissues [11–13]. Whilst mild hyperkalaemia intraoperatively is usually asymptomatic, high plasma levels of potassium may result in cardiac arrhythmias, muscle weakness or paralysis. Understanding this relationship has specific implications for the prevention of severe hyperkalaemia and the immediate monitoring and management of hyperkalaemia in the intra- and postoperative periods, as timely recognition and treatment of complications that arise from hyperkalaemia is imperative
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