Acute and Critical Care

Case Report

Nephrology
Sudden Intraoperative Hyperkalemia during Laparoscopic Radical Nephrectomy in a Patient with Underlying Renal Insufficiency: Sung Hoon Jung, Yun-Joung Han, Sang Ho Shin, Hyo Seon Lee, Ji Young Lee; Acute Crit Care. 2017;33(4):271-275. Published online November 21, 2018; DOI: https://doi.org/10.4266/acc.2016.00696

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We experienced a case of severe intraoperative hyperkalemia during laparoscopic radical nephrectomy in a 60-year-old male patient with renal insufficiency, whose hypertension had been managed by preoperative angiotensin II receptor blocker (ARB) and adrenergic beta-antagonist. After renal vessel ligation, his intraoperative potassium concentration suddenly increased to 7.0 mEq/L, but his electrocardiography (ECG) did not show any significant change. While preoperative ARB therapy has been regarded as a contributing factor for further aggravation of underlying renal insufficiency, we assumed that nephrectomy itself and rhabdomyolysis caused by surgical trauma also aggravated the underlying renal dysfunction and resulted in sudden hyperkalemia. Hyperkalemia was managed successfully with calcium gluconate, insulin, furosemide and crystalloid loading during the intraoperative and immediate postoperative periods, and potassium concentration decreased to 5.0 mEq/L at 8 hours after the operation. The patient’s hospital course was uncomplicated, but his renal function deteriorated further.

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Acute Intraoperative Hyperkalemia During Robot-Assisted Radical Cystectomy: A Case Report
Nivedhyaa Srinivasaraghavan, Vallary Modh, Arun Menon
A&A Practice.2022; 16(12): e01650. CrossRef

Original Article

Cardiology
The Effect of the Valsalva Maneuver on the External Jugular Vein: Ho Sik Moon, Sung Hoon Jung, Sie Hyeon Yoo, Jae Young Ji, Hae Jin Lee; Korean J Crit Care Med. 2015;30(3):158-163. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.158

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Abstract PDF: Background
The external jugular vein (EJV) is a useful intravenous (IV) cannulation site for anesthesiologists, although it has a relatively high failure rate. Unlike other central veins, visualization of the EJV is important during IV cannulation, and the Valsalva maneuver distends the jugular venous system. However, the relationship between the maneuver and EJV visibility remains unknown. This study compared EJV visibility before and after the Valsalva maneuver.
Methods
This was a prospective observational study that included 200 participants. After the induction of anesthesia, EJV visibility grade, depth from the skin to the EJV superficial surface (EJV depth), and EJV cross-sectional area (CSA) before the Valsalva maneuver were measured. The same parameters were measured after the Valsalva maneuver was performed. The EJV visibility grade was defined as grade A: good appearance and good palpation, grade B: poor appearance and good palpation, and grade C: poor appearance and poor palpation.
Results
Patient body mass index and EJV depth affected the EJV visibility grade before the Valsalva maneuver (p < 0.05), although EJV CSA did not. The Valsalva maneuver distended EJV CSA and reduced EJV depth, although these changes were not correlated with EJV visibility grade. With regard to EJV visibility, 34.0% of grade B cases and 20.0% of grade C cases were improved by the Valsalva maneuver.
Conclusions
Although the Valsalva maneuver improved EJV CSA and EJV depth, it did not greatly affect EJV visibility grade.

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