Potassium plays a vital role in perioperative care due to its involvement in cellular fluid balance, cardiovascular stability, neuromuscular function, acid-base balance, wound healing, and complication prevention. Preoperative potassium management can help mitigate fluid and electrolyte disturbances induced by surgical stress, blood loss, and fluid shifts, ensuring stable cellular and cardiovascular function. It’s especially crucial for neuromuscular function during surgery, as potassium imbalances can lead to muscle weakness or paralysis. Moreover, potassium is central to acid-base homeostasis, particularly under metabolic stress. Ensuring adequate potassium levels supports wound healing by facilitating collagen synthesis and cellular repair and can help prevent perioperative complications, including respiratory issues and postoperative ileus. Perioperative potassium optimization is essential for patients at risk, particularly those undergoing major surgeries, to improve outcomes and reduce the likelihood of adverse events.

Mechanisms of Action and Benefits:

• Electrolyte and Fluid Balance: Potassium is essential for maintaining cellular fluid balance, as it is the primary intracellular cation. Surgical stress, blood loss, and fluid shifts can lead to potassium disturbances, which may compromise cellular function and tissue repair. (1)
• Cardiovascular Stability: Potassium is critical for cardiovascular stability, regulating cardiac excitability and preventing arrhythmias. A low potassium level (hypokalemia) is associated with an increased risk of perioperative arrhythmias and complications. (2)
• Neuromuscular Function: Potassium plays an essential role in muscle contraction and nerve transmission, as it is involved in the repolarization phase of the action potential. Potassium imbalances can lead to muscle weakness or paralysis, which is particularly concerning in the perioperative period when neuromuscular function is critical. (3)
• Acid-Base Balance: Potassium is integral to maintaining acid-base balance, a factor critical in the perioperative setting where metabolic disturbances are common. Surgical stress can lead to shifts in potassium levels as the body compensates for pH changes, potentially leading to hypokalemia or hyperkalemia. (4)
• Prevention of Complications: Hypokalemia is associated with several perioperative complications, including respiratory depression and postoperative ileus. Potassium repletion preoperatively is often necessary in patients with low potassium to prevent such issues. (5)

References

1. Sahir S Rassam, David J Counsell, Perioperative electrolyte and fluid balance, Continuing Education in Anaesthesia Critical Care & Pain, Volume 5, Issue 5, October 2005, Pages 157–160
2. Wahr JA, Parks R, Boisvert D, et al. Preoperative Serum Potassium Levels and Perioperative Outcomes in Cardiac Surgery Patients. JAMA. 1999
3. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.105.166563 accessed October 2024
4. Lee Hamm L, Hering-Smith KS, Nakhoul NL. Acid-base and potassium homeostasis. Semin Nephrol. 2013;33(3):257-264. doi:10.1016/j.semnephrol.2013.04.006
5. Penfold JA, Wells CI, Du P, et al. Relationships between serum electrolyte concentrations and ileus: A joint clinical and mathematical modeling study. Physiol Rep. 2021;9(3):e14735. doi:10.14814/phy2.14735