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PEDIATRIC ANESTHESIA

Intraoperative Hypokalemia in Pediatric Liver Transplantation: Incidence and Risk Factors

Victor W. Xia, MD, Bin Du, MD^*, Albert Tran^*, Luke Liu, MD^*, Ke-Qin Hu, MD, Jonathan R. Hiatt, MD, Ronald W. Busuttil, MD, PhD, and Randolph H. Steadman, MD^*

From the Departments of *Anesthesiology and Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Division of Gastroenterology, University of California, Irvine Medical Center, Orange, California; Department of Anesthesiology, 2nd Affiliated Hospital, Kunming Medical College, Kunming, China.

Address correspondence and reprint requests to Victor W. Xia, MD, Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, Box 951778, Los Angles, CA 90095-1778. Address e-mail to vxia{at}mednet.ucla.edu.

In this retrospective study of 268 children undergoing liver transplantation, we investigated the incidence of intraoperative potassium (K⁺) disturbances and the risk factors for hypokalemia in the preperfusion and postreperfusion periods. Overall, hypokalemia was the predominant disturbance, occurring in 72.0% of pediatric patients during liver transplantation. Hypokalemia was more common during the postreperfusion period than the prereperfusion period. Hyperkalemia, though a commonly cited complication, was infrequent during pediatric liver transplantation. Using multivariate logistic regression analysis, baseline serum K⁺ 3.5 mmol/L, base excess >5 mmol/L, and creatinine 0.5 mg/dL were found to be predictors for hypokalemia in the prereperfusion period; and body weight 15 kg, K⁺ 3.5 mmol/L, fresh-frozen plasma transfusion >90 mL/kg, and absence of ascites at surgery were independent predictors for hypokalemia in the postreperfusion period. These findings support the use of K⁺ replacement to maintain normokalemia and avoid the potential complications related to hypokalemia in pediatric liver transplantation, especially in children with the risk factors for hypokalemia.

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				V. W. Xia, R. M. Ghobrial, B. Du, T. Chen, K.-Q. Hu, J. R. Hiatt, R. W. Busuttil, and R. H. Steadman Predictors of Hyperkalemia in the Prereperfusion, Early Postreperfusion, and Late Postreperfusion Periods During Adult Liver Transplantation Anesth. Analg., September 1, 2007; 105(3): 780 - 785. [Abstract] [Full Text] [PDF]