Potassium is a critical electrolyte that plays multiple roles in maintaining physiological homeostasis during the perioperative period. As the primary intracellular cation, potassium regulates cellular fluid balance, neuromuscular excitability, acid-base equilibrium, and cardiovascular rhythm stability—all of which are challenged under surgical stress.

Proper potassium management is essential for minimizing perioperative complications, such as arrhythmias, postoperative ileus, and respiratory compromise. Ensuring optimal levels preoperatively contributes to enhanced recovery by maintaining membrane potentials, facilitating tissue repair, and supporting critical organ function.

Mechanisms of Action and Benefits

Electrolyte and Fluid Balance
Potassium maintains intracellular osmolarity and contributes to the electrochemical gradients necessary for cell volume regulation and nutrient transport. During surgery, potassium is frequently depleted due to blood loss, fluid shifts, and hormonal responses to stress, compromising cellular function and tissue healing [1].

Cardiovascular Stability
Potassium is essential for the repolarization phase of cardiac action potentials. Hypokalemia increases the risk of ventricular arrhythmias, particularly in patients undergoing general anesthesia or cardiac procedures. Maintaining adequate potassium levels reduces the likelihood of perioperative cardiac events [2].

Neuromuscular Function
Through its role in membrane potential regulation, potassium is critical for skeletal muscle contraction and nerve signal transmission. Imbalances can impair muscle function, potentially leading to weakness, paralysis, or difficulty weaning from ventilation postoperatively [3].

Acid-Base Balance
Potassium participates in compensatory mechanisms for metabolic acidosis and alkalosis. Surgical stress often disturbs pH homeostasis, shifting potassium into or out of cells, which may result in hypokalemia or hyperkalemia—both of which increase surgical risk [4].

Prevention of Complications
Low serum potassium levels are associated with increased incidence of postoperative ileus and respiratory depression. Preoperative potassium optimization improves gastrointestinal motility, reduces morbidity, and supports safe anesthetic recovery [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.
   
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.