From the Guidelines
General anesthesia for patients with kidney failure should be approached with caution, and the use of local anesthesia or conscious sedation is preferred whenever possible, as seen in the study by 1. The study by 1 highlights the importance of safe dosage and selection of anesthetic agents in renal failure patients. When general anesthesia is necessary, the choice of anesthetic agents should be guided by their pharmacokinetics and potential impact on renal function. Some key considerations include:
- Using short-acting agents with minimal renal metabolism
- Avoiding nephrotoxic agents
- Careful fluid management to maintain euvolemia
- Monitoring of electrolytes, blood gases, and glucose
- Maintaining adequate blood pressure to ensure renal perfusion The study by 1 provides guidance on the use of local anesthesia and sedation in renal failure patients, including the safe use of lidocaine, mepivacaine, and benzodiazepines such as diazepam and midazolam. However, the study does not provide direct guidance on the use of general anesthesia in these patients. In the absence of specific guidance, it is essential to rely on general principles of anesthetic management in patients with kidney disease, prioritizing the minimization of renal injury and the maintenance of optimal renal perfusion. In clinical practice, this may involve the use of agents such as propofol, etomidate, sevoflurane, and desflurane, which have been shown to have minimal renal effects, as well as careful monitoring and management of fluid and electrolyte balance. Ultimately, the goal of anesthetic management in patients with kidney failure is to minimize the risk of further renal injury while providing effective and safe anesthesia, as emphasized by the study by 1.
From the Research
General Anesthesia for Kidney Failure Patients
- The use of total intravenous anesthesia (TIVA) with remifentanil and propofol in end-stage renal failure patients does not prolong recovery time compared to patients with normal renal function 2.
- A study found that local anesthesia (LA) with monitored anesthesia care or brachial plexus block (BPB) can be safely used in patients with chronic kidney disease and end-stage renal disease undergoing hemodialysis access surgery, avoiding the need for general anesthesia (GA) 3.
- Effective strategies for nephroprotection are crucial for the management of patients with chronic kidney disease (CKD) undergoing surgery, including identification of CKD patients, maintenance of hemodynamic stability, and preservation of intravascular volume 4.
- Hypotensive anesthesia with propofol and remifentanil can result in transient tubular dysfunction in patients without renal disease, which can be minimized by preoperative administration of alpha-tocopherol 5.
- The choice of anesthetic agent, such as propofol, sevoflurane, or desflurane, combined with remifentanil, does not significantly affect the surgical field in endoscopic sinus surgery 6.
Anesthetic Considerations
- Remifentanil and propofol can be used safely in patients with end-stage renal failure, with no significant difference in recovery time compared to patients with normal renal function 2.
- Local anesthesia with monitored anesthesia care or brachial plexus block can be a suitable alternative to general anesthesia in patients with chronic kidney disease and end-stage renal disease undergoing hemodialysis access surgery 3.
- Maintenance of hemodynamic stability and preservation of intravascular volume are crucial for preventing acute kidney injury (AKI) and further deterioration of renal function in patients with CKD 4.
- Preoperative administration of alpha-tocopherol can minimize transient tubular dysfunction caused by hypotensive anesthesia with propofol and remifentanil 5.