The Risk of Sedation/Analgesia in Hemodialysis Patients Undergoing Interventional Procedures

Abstract

Data derived from a large cohort of hemodialysis patients (12,896) undergoing dialysis access maintenance procedures being performed by interventional nephrologists were analyzed to determine the safety of sedation/analgesia (S/A) in a freestanding facility. Data collected included patient demographics, procedures performed, time of procedures, drugs used, doses used, and complications that occurred. Four high-risk groups were identified based upon age, pulmonary status, and over all physical status. These were compared to the total cohort. Midazolam, fentanyl, or a combination of the two were used. Within the total cohort of patients, midazolam alone was used most commonly (94.7%). The total mean dose of midazolam when used alone was 3.4 mg. The dosages used in the high-risk groups tended to be only slightly lower (3-3.2 mg). This setting appears to be safe for hemodialysis patients, even those in high-risk subgroups having these types of procedures. The types of drugs and the dosages that are commonly used do not appear to be associated with an unacceptable risk to the hemodialysis patient. A nephrologist that is not specialty trained in anesthesia is able to provide S/A safely in a freestanding facility.

Changes in the Profile of Endovascular Procedures Performed in Freestanding Dialysis Access Centers over 15 Years

“…NKF-K/DOQI Clinical Practice Guidelines were used for treatment indications and definitions of procedural success (9). Except for tunneled dialysis catheter (TDC) removal procedures, the patients received moderate level sedation/analgesia which was managed according to protocols which have been previously reported (10). All TDCs were placed using both ultrasound and fluoroscopic guidance.…”

Role of interventional nephrology in the multidisciplinary approach to hemodialysis vascular access care

“…However, this aspect of management carries with it a degree of risk, especially considering the ages and comorbidities of the dialysis patient population. To address the question as to whether an interventional nephrologist can administer S/A safely in the outpatient setting, data derived from a cohort of 12,896 hemodialysis patients undergoing dialysis access maintenance procedures performed by interventional nephrologists were analyzed to determine the safety of S/A drug administration in a freestanding DAC [15] . In this study, all medications were administered by the nephrologist performing the procedure who had specific training in S/A.…”

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

“…The total maximum dose of intravenous midazolam was limited to 4 mg in patients with chronic renal failure. 5 The groups were divided according to continuous or intermittent midazolam. Both groups of patients received an intravenous IB dose of midazolam at a dose of 0.015 mg/kg before the start of the surgery.…”

“…Benzodiazepines may have adverse effects and these include a possible increased incidence of respiratory depression especially in elderly patients with comorbidities. 1,[3][4][5] As a result, the recovery period may be prolonged in patients with comorbidities. Remifentanil is a synthetic opioid with unique pharmacokinetic properties including a short onset time and an ultra-short duration of action.…”