Kidney disease affects millions globally. "The prevalence of end-stage renal disease has increased by 20% since 2000" and "more than 10% of the general population globally suffers from chronic kidney disease." Over 2 million people require dialysis or transplantation to survive.
Dialysis patients need anesthesia for various procedures, including catheter insertion and kidney transplants. These patients require "special considerations when receiving anesthesia" due to potential impairment of multiple organ systems. Comprehensive preoperative assessment helps identify and optimize function before surgery.
For access creation procedures, local or regional anesthesia is preferred over general anesthesia. Patients can receive topical anesthetics before arteriovenous fistula cannulation. However, "local anesthetics may have a delayed onset and prolonged duration of action due to low levels of bicarbonate in patients with kidney disease."
Research on lidocaine clearance during hemodialysis shows conflicting results. One study found "the disposition kinetics of lidocaine were the same between healthy individuals and those on hemodialysis," while another discovered hemodialysis removal was "rather negligible." Currently, no clear role exists for dialysis treating anesthetic toxicities.
Postoperative hypotension occurs more frequently when less than 7 hours pass between dialysis and anesthesia. Delaying anesthesia by 7+ hours can minimize this risk, though further research is needed.
When general anesthesia is necessary, several agents are available. Propofol and midazolam risk hypotension; sevoflurane appears safe with no nephrotoxicity observed; and "nitrous oxide, ketamine, desflurane, and isoflurane are all safe."
These complex considerations require careful clinical attention and continued research refinement.