Effect of Regional Anesthesia on Intraoperative Hyperkalemia in Patients With Chronic Kidney Disease: Two Case Reports

Intraoperative hyperkalemia is particularly common in patients with chronic kidney disease (CKD). We report two cases of intraoperative hyperkalemia occurring under general anesthesia, while potassium levels remained stable with regional anesthesia alone. Case 1 involved a 69-year-old male with CKD who underwent total thyroidectomy under general anesthesia and developed intraoperative hyperkalemia, requiring glucose-insulin (GI) therapy. The same patient, however, maintained stable potassium levels during transurethral resection of a bladder tumor performed with spinal anesthesia. Case 2 involved a 72-year-old male with rheumatoid arthritis who underwent artificial joint replacement and tendon transplantation of his finger under a combination of general and regional anesthesia. He developed intraoperative hyperkalemia requiring GI, but stable potassium levels were maintained during bilateral total knee arthroplasty under epidural and spinal anesthesia. Our cases highlight the potential of regional anesthesia to reduce the risk of intraoperative hyperkalemia, particularly in patients with CKD.