Hyperkalemia during liver transplantation, especially within five minutes of reperfusion poses a critical threat, leading to sudden arrhythmias and catastrophic intraoperative events. A systematic review spanning three decades identified multiple high-risk factors, including baseline serum potassium, transfused RBC storage time, metabolic acidosis, low intraoperative urine output, and donor-related variables such as age and prolonged hospital stay. Anesthetic interventions such as bolus catecholamines, angiotensin receptor blockers, and sodium bicarbonate immediately before reperfusion were also linked to severe potassium surges.
These findings underscore the need for rigorous pre-reperfusion potassium optimization and vigilant intraoperative monitoring to reduce morbidity and mortality. To explore the full spectrum of predictors and refine your anesthesia strategy, read the complete…
