Acute and Critical Care

Case Report

Nephrology
Sudden Intraoperative Hyperkalemia during Laparoscopic Radical Nephrectomy in a Patient with Underlying Renal Insufficiency: Sung Hoon Jung, Yun-Joung Han, Sang Ho Shin, Hyo Seon Lee, Ji Young Lee; Acute Crit Care. 2017;33(4):271-275. Published online November 21, 2018; DOI: https://doi.org/10.4266/acc.2016.00696

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We experienced a case of severe intraoperative hyperkalemia during laparoscopic radical nephrectomy in a 60-year-old male patient with renal insufficiency, whose hypertension had been managed by preoperative angiotensin II receptor blocker (ARB) and adrenergic beta-antagonist. After renal vessel ligation, his intraoperative potassium concentration suddenly increased to 7.0 mEq/L, but his electrocardiography (ECG) did not show any significant change. While preoperative ARB therapy has been regarded as a contributing factor for further aggravation of underlying renal insufficiency, we assumed that nephrectomy itself and rhabdomyolysis caused by surgical trauma also aggravated the underlying renal dysfunction and resulted in sudden hyperkalemia. Hyperkalemia was managed successfully with calcium gluconate, insulin, furosemide and crystalloid loading during the intraoperative and immediate postoperative periods, and potassium concentration decreased to 5.0 mEq/L at 8 hours after the operation. The patient’s hospital course was uncomplicated, but his renal function deteriorated further.

Citations

Citations to this article as recorded by

Acute Intraoperative Hyperkalemia During Robot-Assisted Radical Cystectomy: A Case Report
Nivedhyaa Srinivasaraghavan, Vallary Modh, Arun Menon
A&A Practice.2022; 16(12): e01650. CrossRef

Editorial

Cardiology
The Future of Research on Extracorporeal Membrane Oxygenation (ECMO): Ji Young Lee; Korean J Crit Care Med. 2016;31(2):73-75. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.73

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Case Report

Airway Obstruction and Flattening of Arterial Pressure Wave during Whole Lung Lavage: A Case Report: Hyun Jung Koh, Sung Jin Hong, Ho Kyung Song, Ji Young Lee, Jin Young Chon, Ho Sik Moon, Yu Mi Ju, Hyung Mook Lee; Korean J Crit Care Med. 2013;28(2):133-136.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.133

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Abstract PDF: Whole lung lavage (WLL) is a challenging procedure; because lavage fluid may perturb the respiratory and hemodynamic systems. We observed severe airway obstruction and flattening arterial pressure wave during WLL for treatment of pulmonary alveolar proteinosis. The aim of this case report is to discuss the anesthetic requirement in order to prevent bronchospasm during WLL. Furthermore, we discuss the potential of lavage fluid to cause airway obstruction and decrease cardiac outflow through the mass effect.

Original Articles

The Risk Factors of Postoperative Respiratory Insufficiency after Prolonged Robotic Radical Prostatectomy: Jin Young Lee, Ji Young Lee, Sung Jin Hong, Byung Ho Lee, Ou Kyoung Kwon, Young Hee Kim; Korean J Crit Care Med. 2010;25(3):130-135.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.130

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Abstract PDF

BACKGROUND
Robotic radical prostatectomy is performed in elderly patients and requires extreme changes in the patient's position and is often associated with a long surgery time. This study reviewed the pulmonary complications occurring after a robotic radical prostatectomy and analyzed the potential risk factors.
METHODS
The medical records of all patients who had undergone robotic radical prostatectomy at our institution were reviewed. Among the 80 total patients, 58 were capable of spontaneous respiration at the end of surgery (Group I), whereas 22 patients required assisted ventilation (Group II). A comparison between the two groups was made in terms of the demographic characteristics, coexisting diseases, anesthesia and operation time, amount of intraoperative blood loss and transfused blood products.
RESULTS
The mean age of the patients was 67.2 +/- 7.3 years. The mean operation time was 384.1 +/- 203.4 min (range, 195-1,180 min). The anesthesia and operation time, amount of intraoperative blood loss and number of transfused patients were all significantly higher in Group II. Univariate analysis revealed age, body mass index, intraoperative blood loss and transfusion, anesthesia and operation time to be related to postoperative respiratory insufficiency. Multivariate analysis revealed intraoperative transfusion and operation time to be predictive risk factors.
CONCLUSIONS
Prolonged laparoscopic surgery in a steep Trendelenburg position has a high likelihood of postoperative respiratory insufficiency, with the intraoperative transfusion and a longer operation time being possible contributing factors.

Citations

Citations to this article as recorded by

Features of the mechanics of respiration and gas exchange during robot-assisted radical prostatectomy. Review
Ildar I. Lutfarakhmanov, I. A. Melnikova, E. Yu. Syrchin, V. F. Asadullin, Yu. A. Korelov, P. I. Mironov
Annals of Critical Care.2021; (1): 75. CrossRef

The Effect of Blood Transfusion on the Tissue Perfusion and Lung Injury during Cardiopulmonary Bypass: Sung Jin Hong, Se Ho Moon, Choon Ho Sung, Hae Jin Lee, Jin Hwan Choi, Ji Young Lee, Yong Suk Kim; Korean J Crit Care Med. 2004;19(2):98-105.

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Abstract PDF: BACKGROUND
The blood components of priming solution for cardiopulmonary bypass (CPB) may have opposite roles for tissue perfusion, which are the activation of inflammatory reaction and the improvement of oxygen carrying capacity. This study is aimed to investigate the effect of blood transfusion of priming solution on inflammatory response and tissue perfusion. METHODS: Twenty mongrel dogs randomly allocated and received hypothermic CPB with blood- containing (H group, n=10), or non-hemic (NH group, n=10) priming solution. Gastric intramucosal CO2 concentration (PrCO2), intramucosal pH (pHi), interleukin-8 (IL-8), blood gas and hemodynamic parameters were measured at 1) before CPB, 2) 1 hour during CPB, 3) the end of CPB, 4) 2 hours after CPB, 5) 4 hours after CPB. The ratio of wet to dried lung weight was measured. Statistical verification was performed using repeated measures ANOVA and unpaired t-test.
RESULTS
PrCO2 increased and pHi decreased during the study without significant difference between the groups. IL-8 increased in both groups and IL-8 of H group increased higher than that of NH group during the study. The difference between PaCO2 and end-tidal CO2 of NH group was higher than that of H group at 4 hours after CPB. The ratio of wet to dried lung weight was not significantly different between the groups. CONCLUSIONS: We conclude that the allogenic blood in priming solution aggravates the CPB- induced inflammatory reaction, however, the CPB-induced impairment of gastric mucosal perfusion and the pulmonary edema are not significantly affected, compared to non-hemic solution.

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