Title : Effect of intermittent pringle manipulation on serum potassium concentration during laparoscopic hepatectomy: a self-controlled study
Abstract:
Background: Intermittent Pringle Manipulation (IPM) is one of the most common methods used for controlling blood loss during laparoscopic hepatectomy (LH). But ischemia–reperfusion injury (IRI) is associated with IPM. Ischemic injury exposes the liver cells to hypoxia, adenosine triphosphate depletion, pH changes, and cellular metabolic stress, all of which can lead to cell damage and death. Reperfusion injury is caused by microcirculatory dysfunction, hypoxia, oxidative stress, and apoptosis. The pathophysiological mechanism of IRI is hyperkaliemia (HK). HK is closely related to the electrophysiological activity of the myocardium. Acute HK is associated with life-threatening ventricular arrhythmia and cardiac arrest. Therefore, it is necessary to observe changes of serum potassium concentrations [K+] during IPM to provide a reference for developing a secure anesthesia management procedure.
Methods: This was a single-center, open, non-interventional, self-controlled study. All eligible consecutive patients were recruited from a regional medical center and scheduled for elective LH. There was no control group; all participants were continuously enrolled from 1 Sep 2023 to 31 Aug 2024. The primary outcome was the perioperative [K+] during IPM. Secondary outcomes included perioperative electrocardiogram (ECG) changes, postoperative [K+], alanine and aspartate amine transferase, serious adverse events (SAEs), and the length of hospital stay (LHS). These parameters were statistically compared. Subgroup analysis will be performed according to duration of IPM.
Results: A total of 103 patients were collected, among whom the [K+] data of patients at T-1, T0, T1, T2, T3, and T+1 was collected completely. Data from 91 patients were collected at T3, with a missing rate of 11.7%, and data from 15 patients were collected at T4, with a missing rate of 85.4%. For the 103 patients with complete data from T-1 to T3 and T+1, the results of one-way repeated measures ANOVA showed significant differences (F= 59.180, P< 0.001). The results of multiple comparisons showed that there were differences between T0 and T-1, T1, T2, T3, T+1 (P < 0.05), and differences between T2 and T-1, T+1 (P < 0.05). 5.83% of the patients exhibited ECG abnormalities. For the 15 patients with complete data from T-1 to T+1, the results of one-way repeated measures ANOVA showed significant differences (F= 15.594, P < 0.001). The results of multiple comparisons showed that there were differences between T0 and T-1, T1, T2, T3, T4 (P < 0.05), and differences between T+1 and T2, T3 (P < 0.05). 13.33% of the patients exhibited ECG abnormalities. There were no SAEs occurred.
Conclusions: There’re significant variations in [K+] during IPM in LH patients, underscoring the potential risk of HK and associated with ECG abnormalities. These findings emphasize the need for meticulous monitoring of [K+] and cardiac function to ensure safe anesthesia management and prevent SAE during LH.
