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- W4251362681 abstract "To the Editor: We present a case in which intraoperative hemodialysis was used to correct hyperkalemia unresponsive to less invasive treatment during emergency surgery to evacuate an intracranial hematoma. A 20-yr-old patient with end-stage renal disease (ESRD) was hospitalized because of coma with a fixed, dilated right pupil and bilateral extensor plantar responses. Cranial computed tomography demonstrated a right frontoparietal hematoma. The patient was scheduled for emergency surgery. Anesthesia was induced with fentanyl 5 micro gram/kg, thiopental 6 mg/kg, and vecuronium 0.1 mg/kg. Maintenance of anesthesia consisted of nitrous oxide (50%), oxygen (50%), and isoflurane (1%). During craniotomy, a single unit of packed red blood cells was transfused. One hour later, serum potassium had increased to 7 mEq/L (4.3 mEq/L preoperatively). Ten units of regular insulin in 500 mL of 5% dextrose solution was infused, but the electrocardiogram continued to demonstrate peaked T waves compatible with acute hyperkalemia. Thirty milliliters of 10% calcium gluconate solution was given intravenously, and this dose was repeated 5 min later. A repeat serum potassium level had increased to 8.2 mEq/L. As hyperkalemia had not responded to conventional noninvasive treatment, we initiated hemodialysis to remove excess potassium. After 3 h of hemodialysis, the serum potassium level had decreased to 5.1 mEq/L and hemofiltration was terminated. Postoperatively, the patient was moved to the intensive care unit in stable condition. During surgery in patients with ESRD, preoperative hyperkalemia may be aggravated by hypoxia, hypercapnia, tissue trauma, and blood transfusions [1]. As the number of ESRD patients in dialysis programs increases, the incidence of emergency surgical interventions will also increase. For correction of refractory hyperkalemia during emergency surgery, intraoperative hemodialysis represents a useful alternative. Ece Tek, MD Sumru Sekerci, MD Gulnaz Arslan, MD Department of Anesthesiology and Reanimation Baskent University School of Medicine Ankara, Turkey" @default.
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- W4251362681 date "1996-09-01" @default.
- W4251362681 modified "2023-10-16" @default.
- W4251362681 title "Intraoperative Hemodialysis During Emergency Intracranial Surgery" @default.
- W4251362681 doi "https://doi.org/10.1213/00000539-199609000-00044" @default.
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