General Anesthesia is Not Necessary for Hemodialysis Access Surgery

Chronic kidney disease has been identified as a risk factor for mortality after procedures under general anesthesia (GA). However, a recent study showed that 85 per cent of arteriovenous fistulas in the United States are performed under GA. Our aim was to demonstrate that GA can be avoided in patients with chronic kidney disease and end-stage renal disease by using local anesthesia (LA) with monitored anesthesia care or brachial plexus block (BPB) during hemodialysis access surgery. A retrospective review was performed at a single institution. Outcome measures included need for conversion to GA, major perioperative complications, and 30-day mortality. Four hundred and fourteen access procedures were performed by seven vascular surgeons between 2011 and 2014. Arteriovenous fistulas were placed in 379 (92%), arteriovenous grafts were placed in 31 (7%), and four (1%) received unsuccessful extremity exploration. Anesthetic approach was LA in 344 (83%) and BPB in 64 (15%). GA was initially induced in three (0.7%) and three (0.7%) additional patients required conversion to GA from LA. There were no cardiopulmonary events or perioperative deaths. Of the 32 patients who received an arteriovenous graft, only three (10%) required GA. In conclusion, LA and BPB are safe and conversion to GA is rare. GA should be avoided in hemodialysis access surgery.