Gurajala Indira, Nikhar Sapna Annaji, Jayaram Kavitha, Gopinath Ramachandran
Department of Anaesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
J Anaesthesiol Clin Pharmacol. 2018 Jan-Mar;34(1):117-119. doi: 10.4103/0970-9185.168203.
Renal tubular acidosis (RTA) with hypokalemia may precipitate acute respiratory failure and potentially fatal arrhythmias like ventricular fibrillation. Though there are random reports of respiratory failure needing mechanical ventilation and sudden death in patients with RTA and hypokalemia, the anesthetic management of these patients has not been clearly elucidated. Acidosis and hypokalemia have significant interactions with both general and local anesthetics and alter their effect substantially. Proper preoperative planning and optimization are required for the safe conduct of anesthesia in this subset of patients. We describe a case of distal RTA, hypokalemia, and metabolic bone disease in whom central neuraxial anesthesia was effectively used for lower limb orthopedic surgery with no complications.
伴有低钾血症的肾小管性酸中毒（RTA）可能会引发急性呼吸衰竭以及诸如心室颤动等潜在致命性心律失常。尽管有关于RTA合并低钾血症患者需要机械通气的呼吸衰竭及猝死的个别报道，但这些患者的麻醉管理尚未得到明确阐释。酸中毒和低钾血症与全身麻醉药和局部麻醉药均有显著相互作用，并会大幅改变它们的效应。对于这类患者，为安全实施麻醉需要进行恰当的术前规划和优化。我们描述了一例远端RTA、低钾血症和代谢性骨病患者，该患者在接受下肢骨科手术时有效使用了椎管内麻醉，未出现并发症。
