Intravenous regional anesthesia in patients with hypokalemic periodic paralysis

Hypokalemic periodic paralysis is a familial autosomal dominant trait. The paralytic attacks are precipitated by large carbohydrate-rich meals, cold, mental or surgical stress, infections, exercise, drugs, electrolytes and endocrine abnormalities. Death may occur from respiratory arrest, infections, aspiration or cardiac arrhythmias. Anesthesia and surgical procedures may induce an attack and complicate the perioperative patient condition. Guidelines for anesthetic management should include preventive measures i.e. reduce mental stress and carbohydrate intake and correction of electrolytes and endocrine abnormalities. During the operation, measures should include prevention of cold and monitoring of muscle relaxants and ECG. When paralysis is diagnosed, slow (50mEq/hr) IV infusion of potassium is suggested, while monitoring plasma levels of potassium ECG, and facial nerve conduction. We present two patients with hypokalemic periodic paralysis who underwent uneventful orthopedic procedures under IV regional block.