General, regional or local anesthesia for successful radial cephalic arteriovenous fistula

2017 ◽  
Vol 18 (1_suppl) ◽  
pp. S24-S28 ◽  
Author(s):  
David Shemesh ◽  
Yefim Raikhinstein ◽  
Ilya Goldin ◽  
Oded Olsha
Keyword(s):  
General Anesthesia ◽  
Local Anesthesia ◽  
Regional Anesthesia ◽  
Vascular Access ◽  
Early Failure ◽  
Randomized Clinical Study ◽  
Increased Risk ◽  
Time Required ◽  
Plexus Block ◽  
Access Surgery

Autogenous fistulas and in particular radiocephalic fistulas are recommended as the first vascular access for hemodialysis. Unfortunately, the rates of early failure and non-maturation are very high. For more than a decade, brachial plexus block has been proposed as the anesthesia of choice for fistula creation due to its beneficial sympathectomy-like effect, causing vasodilation and attenuation of spasm. Until recently, there was not a single randomized clinical study supporting this proposition. Because performing regional anesthesia is time-consuming and requires expertise, many surgeons prefer local or general anesthesia for vascular access surgery. However, in August 2016 a randomized clinical trial was published showing that regional anesthesia significantly reduces early failure and improves primary and functional patency at 3 months compared to local anesthesia. The aging of the dialysis population, with their attendant morbidity and increased risk for general anesthesia, makes it clear that regional anesthesia is the recommended approach for fistula creation. The excess time required for this approach will decrease with increasing expertise along the learning curve, and will be compensated by a reduction in time that would otherwise be needed for new access construction due to failure of fistulas constructed under local anesthesia.

Effect of General Anesthesia Versus Regional Brachial Plexus Block on Patency of Vascular Access for Hemodialysis

2019 ◽  
Vol 61 ◽  
pp. 7-9
Author(s):  
Bradford L.W. James ◽  
Matthew S. Jorgensen ◽  
Tariq Almerey ◽  
Zhuo Li ◽  
W. Andrew Oldenburg ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
General Anesthesia ◽  
Vascular Access ◽  
Brachial Plexus Block ◽  
Plexus Block

Short Term Outcome of Brachial Plexus Block in Vascular Access Surgery

2013 ◽  
Vol 20 (2) ◽  
pp. 10-15
Author(s):  
Mamoun Al-Basheer ◽  
Ahed Aledwan ◽  
Mohammed Kilani ◽  
Jan Shishani ◽  
Maleeha Jalamdeh
Keyword(s):  
Brachial Plexus ◽  
Vascular Access ◽  
Brachial Plexus Block ◽  
Short Term ◽  
Term Outcome ◽  
Vascular Access Surgery ◽  
Short Term Outcome ◽  
Plexus Block ◽  
Access Surgery

Vascular access surgery can be safely performed in an ambulatory setting

2018 ◽  
Vol 20 (2) ◽  
pp. 195-201 ◽  
Author(s):  
Gaspar Mestres ◽  
Xavier Yugueros ◽  
Nestor Fontseré ◽  
Alejandro Fierro ◽  
Xavier Sala ◽  
...  
Keyword(s):  
Vascular Access ◽  
Univariate Analysis ◽  
Composite Endpoint ◽  
Ambulatory Setting ◽  
Vascular Access Surgery ◽  
Arteriovenous Access ◽  
Hospital Stays ◽  
Plexus Block ◽  
Access Surgery

Introduction: Ambulatory surgery is associated with lower costs, but there is lack of evidence of the safety for ambulatory vascular access surgery. The objective of this study is to substantiate the safety and effectiveness of performing vascular access surgery in an ambulatory setting. Methods: A review of our prospectively maintained database including all vascular access open surgeries (creations and repairs) performed by our Vascular Access Unit between 2013 and 2017 was compiled. Patient comorbidities, surgery details, hospital admission conditions, and 1-week and 1-month follow-up patency and complications (death, infection, bleeding, and readmission/reintervention) were scrutinized. Results: In the last 5 years, 1414 vascular access procedures were performed (67.8% access creations, 32.2% previous access repairs) in 1012 patients. Most surgeries were performed under local anesthesia (59.2%) or axillary plexus block (38.4%) and mainly in an ambulatory setting, without overnight hospital stays (90.9%). During the first postoperative week follow-up, 9 cases (0.6%) needed readmission or reintervention; significant infection materialized in 11 (0.8%) and 10 cases (0.7%) showed noteworthy hematoma or bleeding, only three (0.2%) requiring reintervention. The primary composite endpoint of 24-h death and 1 week readmission, reintervention, infection, or bleeding was 1.9% (27 cases); 1-month access failure was 6.2%. After univariate analysis, ambulatory settings were not related to higher rates of complications or readmissions. Conclusion: Arteriovenous access surgery can be safely performed in an ambulatory setting, in spite of complex cases, comorbidities, or the increasing implementation of axillary plexus blocks. Surgical results and patency are good, and complications necessitating readmission remain very low.

scholarly journals The importance of anesthesiological methods in the creation of arteriovenous fistulas

2021 ◽  
Vol 8 (3) ◽  
pp. 1068
Author(s):  
Radojica V. Stolić ◽  
Snezana Markovic-Jovanovic ◽  
Vladan Perić ◽  
Vekoslav Mitrović ◽  
Goran Relić ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Arteriovenous Fistula ◽  
Local Anesthesia ◽  
Motor Neurons ◽  
Individual Characteristics ◽  
Fistula Formation ◽  
Arteriovenous Fistulas ◽  
Increased Risk ◽  
Wide Range ◽  
Stage Renal Disease

All anesthesia procedures represent a real danger to life in patients with renal insufficiency, which is why these patients are classified in category IV, so anesthesia procedures for this population are adjusted depending on their individual characteristics. Although local and general anesthesia are acceptable modalities for arteriovenous fistula formation, it is known that local anesthesia is associated with tissue reduction and edema, which may be associated with reduced electrocautery efficiency, increased risk of infection, and vasospasm, especially with repeated injections. It must be noted that there is no consensus on whether an arteriovenous fistula should be created under local, regional, or general anesthesia. Still, it is considered that regional block anesthesia provides reduced vasospasm of blood vessels, provokes venodilatation and complete sensory and blockade of motor neurons, as well as higher primary functional rates in the first 3 months, since its creation, compared with local anesthesia. Overall, patients with end-stage renal disease are a group of patients with a wide range of comorbidities which, along with chronic kidney damage, increase the risk of perioperative anesthetic complications, especially when subjected to general anesthesia. Therefore, alternative modes of anesthesia, such as local and regional blockade, could bring obvious benefits to these patients. It can be concluded that the choice of anesthesia method is determined by several interrelated factors, anesthesiologist, patient and the surgeon, which implies expertise, inclination, habits, practicality, and norms.

Looking for the Benefit of Regional Anesthesia in Dialysis Access Surgery

2019 ◽  
Vol 24 (2) ◽  
pp. 39-43
Author(s):  
Sean Malarkey ◽  
Bart Chess
Keyword(s):  
Local Anesthesia ◽  
Regional Anesthesia ◽  
Retrospective Review ◽  
Dialysis Access ◽  
Single Center ◽  
Venous Graft ◽  
Preoperative Ultrasound ◽  
Access Surgery ◽  
Ultrasound Testing

Highlights Single center, retrospective review. Regional anesthesia is associated with improved distal access configuration with acceptable patency rates when compared with local anesthesia. The use of regional anesthesia allows for improved likelihood of achieving the most distal access possible based on preoperative ultrasound testing and could potentially change from a planned arterial-venous graft to an autogenous creation.

Regional Anesthesia for Vascular Access Surgery

2009 ◽  
Vol 109 (3) ◽  
pp. 976-980 ◽  
Author(s):  
Elizabeth B. Malinzak ◽  
Tong J. Gan
Keyword(s):  
Regional Anesthesia ◽  
Vascular Access ◽  
Vascular Access Surgery ◽  
Access Surgery

scholarly journals Ultrasound-Guided Combined Interscalene-Cervical Plexus Block for Surgical Anesthesia in Clavicular Fractures: A Retrospective Observational Study

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Onur Balaban ◽  
Turan Cihan Dülgeroğlu ◽  
Tayfun Aydın
Keyword(s):  
General Anesthesia ◽  
Regional Anesthesia ◽  
Fracture Repair ◽  
Complication Rates ◽  
Clavicular Fracture ◽  
Ultrasound Guided ◽  
Cervical Plexus ◽  
Cervical Plexus Block ◽  
Plexus Block ◽  
Fracture Surgery

Objective. We aim to report our experiences regarding the implementation of the ultrasound-guided combined interscalene-cervical plexus block (CISCB) technique as a sole anesthesia method in clavicular fracture repair surgery. Materials and Methods. Charts of patients, who underwent clavicular fracture surgery through this technique, were reviewed retrospectively. We used an in-plane ultrasound-guided single-insertion, double-injection combined interscalene-cervical plexus block technique. During the performance of each block, the block areas were visualized by using a linear transducer, and the needles were advanced by using the in-plane technique. Block success and complication rates were evaluated. Results and Discussion. 12 patients underwent clavicular fracture surgery. Surgical regional anesthesia was achieved in 100% of blocks. None of the patients necessitated conversion to general anesthesia during surgery. There were no occurrences of acute complications. Conclusions. The ultrasound-guided combined interscalene-cervical plexus block was a successful and effective regional anesthesia method in clavicular fracture repair. Prospective comparative studies would report the superiority of the regional technique over general anesthesia.

Ultrasound-Guided Costoclavicular Approach Infraclavicular Brachial Plexus Block for Vascular Access Surgery

2017 ◽  
Vol 18 (5) ◽  
pp. e57-e61 ◽  
Author(s):  
Zhi Yuen Beh ◽  
Mohd Shahnaz Hasan
Keyword(s):  
Brachial Plexus ◽  
Vascular Access ◽  
Brachial Plexus Block ◽  
Morbidly Obese ◽  
Ultrasound Guided ◽  
Vascular Access Surgery ◽  
Obstructive Sleep ◽  
Infraclavicular Brachial Plexus Block ◽  
Plexus Block ◽  
Access Surgery

Introduction We report the use of a newly described regional technique, ultrasound-guided costoclavicular approach infraclavicular brachial plexus block for surgical anesthesia in two high-risk patients undergoing 2nd stage transposition of basilic vein fistula. Methods Both patients had features of difficult airway, American Society of Anesthesiologists (ASA) physical status class III and central venous occlusive disease. The common approach, i.e., ultrasound-guided supraclavicular brachial plexus block was technically difficult with inherent risk of vascular puncture due to dilated venous collaterals at the supraclavicular area possibly compromising block quality. The risk of general anesthesia (GA) was significant as patients were morbidly obese with possible risk of obstructive sleep apnea postoperatively. As an alternative, we performed the ultrasound-guided costoclavicular approach infraclavicular brachial plexus block with 20 mL local anesthetic (LA) ropivacaine 0.5% delivered at the identified costoclavicular space using in-plane needling technique. Another 10 mL of LA was infiltrated along the subcutaneous fascia of the proximal medial aspect of arm. Results Both surgeries of >2 hours’ duration were successful, without the need of further local infiltration at surgical site or conversion to GA. Conclusions Ultrasound-guided costoclavicular approach can be an alternative way of providing effective analgesia and safe anesthesia for vascular access surgery of the upper limb.

scholarly journals Mortality and Urological Complications After Open Groin Hernia Repair in Local, General, and Regional Anesthesia: A Nationwide Linked Register Study

2019 ◽  
pp. 145749691987758
Author(s):  
J. H. H. Olsen ◽  
K. Andresen ◽  
S. Öberg ◽  
L. Q. Mortensen ◽  
J. Rosenberg
Keyword(s):  
Confidence Interval ◽  
Hernia Repair ◽  
General Anesthesia ◽  
Urinary Retention ◽  
Local Anesthesia ◽  
Regional Anesthesia ◽  
Odds Ratio ◽  
Groin Hernia ◽  
Groin Hernia Repair ◽  
Urological Complications

Background and Aims: The choice of anesthesia method may influence mortality and postoperative urological complications after open groin hernia repair. We aimed to investigate the association between type of anesthesia and incidence of urinary retention, urethral stricture, prostate surgery, and 1-year mortality after open groin hernia repair. Materials and Methods: Data were linked from the Danish Hernia Database, the national patient register, and the register of causes of death. We investigated data on male adult patients receiving open groin hernia repair from 1999 to 2013 with either local anesthesia, regional anesthesia, or general anesthesia. In relation to the type of anesthesia, we compared mortality and urological complications up to 1 year postoperatively. We adjusted for covariates in a logistic regression assessing urological complications and with the Cox regression assessing mortality. Results: We included 113,069 open groin hernia repairs in local anesthesia, regional anesthesia, or general anesthesia. The risk of urinary retention adjusted for covariates was higher after both general anesthesia (adjusted odds ratio = 1.64, 95% confidence interval = 1.05–2.57, p = 0.031) and regional anesthesia (odds ratio = 2.99, 95% confidence interval = 1.67–5.34, p < 0.0005) compared with local anesthesia. The adjusted risk of prostate surgery was also higher for both general anesthesia (odds ratio = 1.58, 95% confidence interval = 1.23–2.03, p < 0.0005) and regional anesthesia (odds ratio = 1.90, 95% confidence interval = 1.40–2.58, p < 0.0005) compared with local anesthesia. Type of anesthesia did not influence 1-year mortality or the risk for urethral stricture. Conclusion: Patients undergoing open groin hernia repair in local anesthesia experience the lowest rate of urological complications and have equally low mortality compared with patients undergoing repair in general anesthesia or regional anesthesia.

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