Vascular access surgery anesthesia

Local anesthesia and regional blocks, commonly used in vascular access surgery, may affect vein diameter and fistula blood flow rates, which are important predictors of fistula failure. Regional block anesthesia (brachial plexus block) is associated with vasodilation in both the cephalic and basilic veins and with increased fistula blood flow. 

Preoperative assessment of coronary status and cardiovascular function is based on clinical evaluation, noninvasive and invasive diagnostic testing. Physical performance is evaluated according to simple exercise tasks (e.g. walking up stairs), and is quantified by grading their metabolic equivalent (MET, table 1). At a performance of 4 MET or more, the patient is usually fit for vascular access surgery in locoregional anesthesia (ERA) without further cardiac evaluation [6]. 

Patients with moderate to severe pulmonary disease requiring vascular access surgery will benefit most from a LRA technique. General anesthesia (GA) with intermittent positive pressure ventilation (IPPV) and use of muscle relaxants impairs respiration more than LRA with maintained spontaneous breathing. IPPV may cause dynamic overinflation or barotrauma to lungs, promote atelectasis and impair mucociliary clearance [7]. This may be associated with increased pulmonary morbidity, prolonged hospital stay, resource utilization and cost. 

As a consequence, use of ultrasound guidance for anesthesia preparations is strongly recommended as an important safety feature in vascular access surgery. 

Shemesh D, Raikhinstein Y, Orkin D, Goldin I, Olsha O Anesthesia for vascular access surgery. J Vase Access 2014 15(suppl 7) S38-... 

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