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Anesthesiology pp 657-665 | Cite as

Anesthesia for AV Fistulas (Upper Extremity)

  • Kavitha A. Mathew
  • Joseph V. Schneider
Chapter

Abstract

Patients requiring surgery to create an arteriovenous (AV) fistula are those suffering end stage renal disease, or advanced chronic kidney disease with anticipated progression and future need for hemodialysis. Managing these patients in the perioperative period is challenging due to their underlying disease as well as multiple comorbidities often present in vascular surgery patients. Particularly concerning in patients presenting for AV fistula is an accurate assessment of their electrolyte balance and volume status. A day-of-surgery physical exam, as well as information regarding the patient’s last dialysis session must be evaluated prior to proceeding to the operating room. AV fistulas can be placed under general anesthesia, monitored anesthesia care with local anesthetic, or regional anesthesia.

Keywords

Arteriovenous fistula End-stage kidney disease (ESRD) Chronic kidney disease Hemodialysis (HD) Peripheral nerve block (interscalene, supraclavicular, infraclavicular, axillary) 

References

  1. 1.
    U.S Renal Data System Annual Report 2015: Atlas of end-stage renal disease in the United States. Centers for Medicare and Medicaid Services. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2015.Google Scholar
  2. 2.
    U.S Renal Data system USRDS 2008 annual data report: Atlas of end-stage renal disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2008.Google Scholar
  3. 3.
    Goodkin DA, et al. Association of comorbid conditions and mortality in hemodialysis patients in Europe, Japan, and the United States: the Dialysis Outcomes and Practice Patterns Study (DOPPS). J Am Soc Nephrol. 2003;14:3270–7.CrossRefPubMedGoogle Scholar
  4. 4.
    National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Vascular Access, 2006 updates. Am J Kidney Dis. 2001;37:S137–81.CrossRefGoogle Scholar
  5. 5.
    Hemodialysis Adequacy 2006 Work Group. Clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis. 2006;48(Suppl 1):S2–90.Google Scholar
  6. 6.
    Trainor D, Borthwick E, Ferguson A. Perioperative management of the hemodialysis patient. Semin Dial. 2011;24:314–26.CrossRefPubMedGoogle Scholar
  7. 7.
    Weiner D, Tighiouart H, Amin M, Stark P, MacLeod B, Griffith J, Sarnak M. Chronic kidney disease is a risk factor for cardiovascular disease and all-cause mortality: a pooled analysis of community-based studies. J Am Soc Nephrol. 2004;15:1307–15.CrossRefPubMedGoogle Scholar
  8. 8.
    Levin A. Clinical epidemiology of cardiovascular disease in chronic kidney disease prior to dialysis. Semin Dial. 2003;16(2):101–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Goldman L, Caldera DL, Nussbaum SR, Southwick FS, Krogstad D, Murray B, Burke DS, O'Malley TA, Goroll AH, Caplan CH, Nolan J, Carabello B, Slater EE. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977;297(16):845–50.CrossRefPubMedGoogle Scholar
  10. 10.
    Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila-Roman VG, Gerhard-Herman MD, Holly TA, Kane GC, Marine JE, Nelson MT, Spencer CC, Thompson A, Ting HH, Uretsky BF, Wijeysundera DN. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130(24):2215–45.CrossRefPubMedGoogle Scholar
  11. 11.
    American Society of Anesthesiologists, Position on Monitored Anesthesia Care (Oct 16, 2013). Accessed from: www.asahq.org/~/media/Sites/ASAHQ/.../position-on-monitored-anesthesia-care.pdf
  12. 12.
    Pecoits-Filho R, Bucharles S, Barberato SH. Diastolic heart failure in dialysis patients: mechanisms, diagnostic approach, and treatment. Semin Dial. 2012;25:35–41.CrossRefPubMedGoogle Scholar
  13. 13.
    Kawar B, Ellam T, Jackson C, Kiely DG. Pulmonary hypertension in renal disease: epidemiology, potential mechanisms and implications. Am J Nephrol. 2013;37(3):281–90.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    KDOQI. KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis. 2007;50:471–530.CrossRefGoogle Scholar
  15. 15.
    Khavanin Zadeh M, Gholipour F, Hadipour R. The effect of hemoglobin level on arteriovenous fistula survival in Iranian hemodialysis patients. J Vasc Access. 2008;9(2):133–6.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Schonberger RB. Fluid, electrolyte and acid-base disorders. In: Hines RL, Marschall KE, editors. Stoelting’s Anesthesia and co-existing disease. Philadelphia: Saunders (Elsevier); 2012. p. 366.Google Scholar
  17. 17.
    Ehrenfeld JM, Sedykh A, Furman W. Management of potassium abnormalities on the day of surgery: a retrospective review. Abstract presentation. Chicago, IL: American Society of Anesthesiologists; 2011.Google Scholar
  18. 18.
    O’Malley C, et al. A randomized, double-blind comparison of lactated Ringer’s solution and 0.9% NaCl during renal transplantation. Anesth Analg. 2005;100:1518–24.CrossRefPubMedGoogle Scholar
  19. 19.
    Potura E, et al. An acetate-buffered balanced crystalloid versus 0.9% saline in patients with end-stage renal disease undergoing cadaveric renal transplantation: a prospective randomized controlled trial. Anesth Analg. 2015;120:123–9.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Evans CH, Lee J, Ruhlman MK. Optimal glucose management in the perioperative period. Surg Clin North Am. 2015;95(2):337–54.CrossRefPubMedGoogle Scholar
  21. 21.
    Duggan EW, Klopman MA, Berry AJ, Umpierrez G. The Emory University Perioperative Algorithm for the management of hyperglycemia and diabetes in non-cardiac surgery patients. Curr Diab Rep. 2016;16(3):34.CrossRefPubMedGoogle Scholar
  22. 22.
    Duggan EW, Carlson KT, Umpierrez GE. Perioperative hyperglycemia management, an update. Anesthesiology. 2017;126(3):547–60.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Joshi GP, Chung F, Vann MA, Ahmad S, Gan TJ, Goulson DT, et al. Society for ambulatory anesthesia consensus statement on perioperative blood glucose management in diabetic patients undergoing ambulatory surgery. Anesth Analg. 2010;111(6):1378–87.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Cronenwett JA. Rutherford’s vascular surgery. 8th ed. Philadelphia, PA: Elsevier Inc.; 2014.Google Scholar
  25. 25.
    Solomonson M, Johnson M, Ilstrup D. Risk factors in patients having surgery to create an arteriovenous fistula. Anesth Analg. 1994;79:694–700.CrossRefPubMedGoogle Scholar
  26. 26.
    Son A, Mannoia K, Herrera A, Chizari M, Hagdoost M, Molkara A. Dialysis access surgery: does anesthesia type affect maturation and complication rates? Ann Vasc Surg. 2016;33:116–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Aitken E, Jackson A, Kearns R, Steven M, Kinsella J, Clancy M, Macfarlane A. Effect of regional versus local anaesthesia on outcome after arteriovenous fistula creation: a randomised controlled trial. Lancet. 2016;388:1067–74.CrossRefPubMedGoogle Scholar
  28. 28.
    Sahin L, Gul R, Mizrak A, Deniz H, Sahin M, Koruk S, et al. Ultrasound-guided infraclavicular brachial plexus block enhances postoperative blood flow in arteriovenous fistulas. J Vasc Surg. 2011;54(3):749–53.CrossRefPubMedGoogle Scholar
  29. 29.
    Siracuse JJ, Gill HL, Parrack I, Huang ZS, Schneider DB, Connolly PH, Meltzer AJ. Variability in anesthetic considerations for arteriovenous fistula creation. J Vasc Access. 2014;15(5):364–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Bridion (package insert). Whitehouse Station, MJ. Merck & Co., Inc.; 2015.Google Scholar
  31. 31.
    De Tran QH, Clemente A, Doan J, Finlayson RJ. Brachial plexus blocks: a review of approaches and techniques. Can J Anesth. 2007;54(8):662–74.CrossRefPubMedGoogle Scholar
  32. 32.
    Melzer J. Renal physiology. In: Hemmings HC, Egan TD, editors. Pharmacology and Physiology for Anesthesia. Philadelphia: Saunders (Elsevier); 2013.Google Scholar
  33. 33.
    Precedex (package insert). Lake Forest, IL: Hospira Inc.; 2008.Google Scholar
  34. 34.
    Al-Jaishi AA, Liu AR, Lok CE, Zhang JC, Moist LM. Complications of the arteriovenous fistula: a systematic review. J Am Soc Nephrol. 2017;28:1839–50.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Emory University School of MedicineAtlantaUSA
  2. 2.Department of AnesthesiologyEmory University School of MedicineAtlantaUSA

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