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General Anesthesia Is Not Necessary for Hemodialysis Access Surgery
Jerry J Kim1, Gurpreet Dhaliwal, Gloria Y Kim
1Department of Surgery, Harbor-UCLA Medical Center, Torrance, California, USA.
The American Surgeon
|October 15, 2015
Summary
General anesthesia (GA) can be avoided for hemodialysis access surgery in patients with chronic kidney disease. Local anesthesia (LA) or brachial plexus block (BPB) are safe alternatives, minimizing risks associated with GA.
Area of Science:
- Nephrology
- Anesthesiology
- Vascular Surgery
Background:
- Chronic kidney disease (CKD) increases mortality risk after general anesthesia (GA).
- A high percentage (85%) of arteriovenous fistulas are performed under GA in the US.
- GA poses significant risks for patients with CKD and end-stage renal disease (ESRD).
Purpose of the Study:
- To evaluate the safety and efficacy of avoiding GA in hemodialysis access surgery for CKD/ESRD patients.
- To demonstrate that local anesthesia (LA) with monitored anesthesia care or brachial plexus block (BPB) are viable alternatives to GA.
- To reduce perioperative complications and mortality in this vulnerable patient population.
Main Methods:
- Retrospective review of 414 hemodialysis access procedures performed between 2011 and 2014.
- Analysis of anesthetic techniques used: LA, BPB, and GA.
- Outcome measures included conversion to GA, major perioperative complications, and 30-day mortality.
Main Results:
- LA was used in 83% and BPB in 15% of cases, with GA used initially in only 0.7%.
- Conversion to GA was required in only 0.7% of cases.
- No cardiopulmonary events or perioperative deaths were recorded; arteriovenous graft procedures rarely required GA (10%).
Conclusions:
- Local anesthesia and brachial plexus block are safe and effective for hemodialysis access surgery in CKD/ESRD patients.
- Conversion to general anesthesia is infrequent, supporting the avoidance of GA.
- General anesthesia should be avoided in hemodialysis access surgery whenever possible to improve patient safety.
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