The importance of anesthesiological methods in the creation of arteriovenous fistulas

Authors

  • Radojica V. Stolić University of Kragujevac, Serbia, Faculty of Medical Sciences, Department of Internal Medicine, Serbia http://orcid.org/0000-0002-6215-9258
  • Snezana Markovic-Jovanovic University of Pristina/K.Mitrovica, Serbia, Medical Faculty Pristina/K.Mitrovica, Serbia
  • Vladan Perić University of Pristina/K.Mitrovica, Serbia, Medical Faculty Pristina/K.Mitrovica, Serbia
  • Vekoslav Mitrović University of East Sarajevo, Faculty of Medicine Foca, Republika Srpska, Bosnia and Herzegovina
  • Goran Relić University of Pristina/K.Mitrovica, Serbia, Medical Faculty Pristina/K.Mitrovica, Serbia
  • Kristina Bulatović University of Pristina/K.Mitrovica, Serbia, Medical Faculty Pristina/K.Mitrovica, Serbia
  • Saša Sovtić University of Pristina/K.Mitrovica, Serbia, Medical Faculty Pristina/K.Mitrovica, Serbia
  • Branka Mitić University of Niš, Serbia, Faculty of Medicine, Serbia

DOI:

https://doi.org/10.18203/2349-2902.isj20210954

Keywords:

Anesthesiology, Arteriovenous fistula, Local anesthesia, Regional block anesthesia, General anesthesia

Abstract

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.

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Published

2021-02-25

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Review Articles