Comparison of nebulized salbutamol and glucose-insulin for preventing acute hyperkalemia in liver transplantation: a randomized, double-blind trial.

purposeCardiac arrest due to a sharp increase in serum potassium one minute after reperfusion in liver transplantation (LT) is fatal. We sought to compare prophylactic nebulized salbutamol versus glucose-insulin for decreasing potassium during reperfusion and to guide the selection of potassium reduction strategies in LT.

methodsWe conducted a randomized, double-blind trial, enrolled patients undergoing LT with preoperative baseline serum potassium levels ≥ 4 mmol/L. Patients were randomized into two groups to receive either glucose-insulin (Group A) or nebulized salbutamol (Group B) as preventive potassium reduction regimens. The primary outcome was the incidence of hyperkalemia (defined as serum potassium > 5.5 mmol/L) 30 s after reperfusion (Rep1).

resultsOne hundred participants were included in the analysis. The incidence of hyperkalemia at Rep1 was significantly lower in Group B than in Group A (36% vs. 56%, P = 0.045). Following administration and prior to reperfusion, the lowest potassium levels were achieved at 30 min in Group A and 45 min in Group B, respectively. The maximum decrease in the serum potassium level was significantly greater in Group B (P < 0.001). No significant differences in the incidence of postreperfusion syndrome were observed between the groups. Surprisingly, Group B had milder blood glucose fluctuations, higher heart rate and mean arterial pressure, lower driving pressure, and lower incidence of postoperative atelectasis.

conclusionNebulized salbutamol is superior to glucose-insulin for preventing acute hyperkalemia during the reperfusion period and may benefit patients undergoing LT. CLINICAL TRIAL NOTATION: Trial registration no. NCT05589441 ClinicalTrials.gov.