CASE 1

A patient suffered cardiac arrest in theatre due to hyperkalaemia and it was noted that the patient was known to be a haemodialysis patient. Bloods were not checked immediately pre-theatre.

CASE 2

Dialysis patient was admitted for cataract surgery which was performed under general anaesthesia (GA). No blood tests taken post op. Patient discharged and readmitted later that day with life-threatening hyperkalaemia of 8.8, likely due to GA requiring ITU admission for continuous veno-venous haemofiltration (CVVH).

Commentary

Preoperative preparation of patients requiring haemodialysis involves coordination with the dialysis team to ensure that the patients fluid status and electrolyte balance is optimised and uraemic toxins are cleared, to minimise the impact of fluid shifts.  This usually involves scheduling dialysis the day before surgery so that heparin used for haemodialysis does not cause perioperative bleeding. ¹ 

These cases are a reminder that anaesthetists need to confirm that pre-operative haemodialysis has occurred as planned and to check post-dialysis full blood count and electrolyte results.

Reference

1. Kanda H, Hirasaki Y, Iida T, et al. Perioperative Management of Patients With End-Stage Renal Disease. J Cardiothorac Vasc Anesth 2017; 31: 2251–67