Regional Anesthesia for Arteriovenous Fistula Surgery May Reduce Hospital Length of Stay and Reoperation Rates

Abstract

Use of regional anesthesia is associated with a shorter postoperative length of stay after arteriovenous fistula surgery and lower risk of reoperation compared to general anesthesia or monitored anesthesia care/IV sedation. Regional anesthesia may be an excellent choice for arteriovenous fistula surgery to reduce postoperative length of stay and risk of reoperation.

Continuous intravenous versus intermittent bolus midazolam with remifentanil during arteriovenous fistula placement with monitored anesthesia care in chronic renal failure patients: a randomized controlled trial

“…These results show us that while using intravenous midazolam in end-stage renal failure, there is a need for careful dose titration, and to prevent adverse events during the procedure, the rescue medication needs to be carefully selected. [12][13][14][15][16] The total dose of midazolam is restricted in chronic renal failure. 8,10,14 In several studies the total mean dose of midazolam has been restricted to between 3.4 mg and 7 mg. 5,13 In a large cohort of study including 12 896 hemodialysis patients undergoing dialysis access maintenance procedures with sedation the total mean dose of midazolam when used alone was 3.4 mg. 5 There are physiological changes that also affect the pharmacokinetics of the drugs in patients with renal disease.…”

“…15 Because of these factors, total midazolam dose should be decreased at a rate of 30-50% in patients with chronic renal disease. 15,16 In our study, we limited our total dose of intravenous midazolam to 4 mg during arteriovenous fistula procedures, which usually takes place at a duration of one to two hours. Continuous use of midazolam has been used for several in-hospital procedures in previous studies and continuous infusion of midazolam was considered a satisfactory sedation technique without significant adverse events when the dose is adjusted appropriately.…”

“…Continuous use of midazolam has been used for several in-hospital procedures in previous studies and continuous infusion of midazolam was considered a satisfactory sedation technique without significant adverse events when the dose is adjusted appropriately. 4,[15][16][17] The major adverse effects associated with midazolam administration are related to pulmonary and cardiovascular events. 10-12-16,18 In our study, intravenous midazolam as a continuous infusion did not cause an increase in the reported adverse event rates.…”

“…Our findings are similar to the previous studies that hospital stay was not prolonged in neither our study group of patients. 2,16,21 Another important issue for discussion is patient and surgeon satisfaction. 22 In our study, although patient satisfaction was similar between groups, surgeons reported better satisfaction in the continuous infusion study group.…”

Comparison of Jaw Elevation Device vs. Conventional Airway Assist during Sedation in Chronic Kidney Diseases Undergoing Arteriovenous Fistula Surgery: A Randomized Controlled Trial

“…Patients with chronic renal failure (CRF) are known to show a high prevalence of obstructive sleep apnea (OSA), which is often under recognized before surgery [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. Arteriovenous fistula (AVF) surgery for these patients can be performed under either general anesthesia (GA) or sedation, with more preference for sedation over GA these days [ 13 ]. With a proper use of sedative agents and monitoring, sedation is safe and reliable, but there are concerns about airway management, especially in patients at risk for OSA.…”