Hypokalemic periodic paralysis
A 45-year-old man was scheduled for molar extraction under general anesthesia. The patient was assessed having an American Society of Anesthesiology (ASA) 1 status after thorough preoperative evaluation. The patient fasted for 8hours prior to surgery. In the pre-operative room, a 20-gauge i.v. cannula was placed after infiltration with 2% lidocaine and an infusion of 5% dextrose normal saline. In operating room, standard monitors were fixed. The patient was anaesthetized with 1 mg intravenous midazolam, 100 μg fentanyl followed by 120 mg propofol and laryngeal mask was inserted and patient maintained on oxygen, nitrous oxide, and isoflurane on spontaneous ventilation. The surgical procedure was completed within 30 min and the patient was transferred to the post-anesthesia care unit. Recovery nurse informed us about the flaccidity of the limbs though vital parameters remained absolutely normal.\nOn assessment, patient was not having any sensory loss and responded well to cold sensations and light touch but motor power in lower limbs was 2/5, upper limb was 3/5 even 5 h after surgery, but there was no difficulty in breathing and patient maintained oxygen saturation on room air. We decided to send high dependency unit (HDU) profile. HDU profile revealed patient having hypokalemia with potassium level of 2 mmol/l. Electro cardio graph (ECG) record also showed features of hypokalemia. Potassium infusion was started (10 meq/h KCl [2 meq/ml] administered at 5 ml/h through peripheral vein) and the patient started recovery and full motor power was regained after 6 h. After exhaustive counseling, patient's relative revealed history of early exhaustion and some muscular weakness felt by patient after sweating or hard work and this disappeared after fluid intake. Post-operative pain management was provided by intravenous paracetamol. He was discharged from the hospital on fourth post-operative day during which time he continued to show no evidence of muscle weakness.