Hyperkalemia in Adolescent Idiopathic Scoliosis Patients with Tranexamic Acid Administration

Introduction:

Tranexamic acid (TXA) is used intraoperatively to reduce blood loss in various fields such as obstetrics, spine, and major joint replacement surgeries. Between May and June 2022, we identified more than three cases of intraoperative hyperkalemia that we believed to be influenced by TXA administration in our adolescent idiopathic scoliosis posterior spinal fusion (AISPSF) patient population.

Methods:

A systematic review of our intraoperative hyperkalemia patients was conducted and narrowed to three patients with minimal pharmacodynamic, metabolic, or pathological influences. Each patient’s timeline of intraoperative hyperkalemia was charted along with medical interventions to reduce patient’s potassium levels.

Results:

Patients 1-3 received a bolus of 5000 mg TXA an hour prior to the initial incision. Their maintenance doses were set to 10 mg/kg/hr, with infusion rates ranging from 4.95 mL/kg – 8.93 mL/kg. TXA administration was halted when potassium levels exceeded 5.5 mmol/L, and anesthetic intervention ensued to ensure patients rapidly reduced intraoperative potassium and avoided any unnecessary untoward effects of hyperkalemia. Of note, most interventions involved the administration of 10% CaCl, four puffs of (45 mcg/act) Levalbuterol, and an increase in ventilation in addition to cessation of TXA administration. Cessation of TXA administration alone was able to reduce hyperkalemia as well.

Conclusion:

Upon initial review, we could not identify preoperative factors or intraoperative changes that could have led to hyperkalemia. To prevent potential complications associated with acute intraoperative hyperkalemia, we are currently working on a retrospective review of institutional TXA administration for AISPSF cases and matching patients that did and did not suffer from episodes of intraoperative hyperkalemia by age, gender, diagnosis, levels of surgery, length of procedure, and preoperative potassium to better identify the influence TXA administration plays on AISPSF intraoperative hyperkalemia.