Does regional anesthesia influence early outcome of upper arm arteriovenous fistula?
To assess the effect of regional anesthesia on the outcome of elbow arteriovenous fistula (AVF), prospectively studied consecutive patients with end-stage renal disease referred for permanent vascular access to the Vascular Unit of King Fahd University Hospital between September 2004 and September 2007. The patients were divided into 2 groups: Group 1: patients who underwent the construction of the AVF under regional anesthesia and Group 2: patients who were operated under general anesthesia, indicated by their preferences or failure of regional anesthesia. Data including patient characteristics and type of AVF were recorded. The internal diameter of the vein and the artery and intra-operative blood flow were measured. The complications of both types of anesthesia were recorded. The patients were followed up for three months. Eighty four cases were recruited in this study. Complete brachial plexus block was achieved in 57 (68%) patients. Seven patients were converted to general anesthesia and 20 patients had AVF under general anesthesia from the start. There were no significant differences between the 2 groups with regard to basic characteristics or operative data. There were no instances of systemic toxicity, hematomas, or nerve injury from the regional block. No major complications were reported from the general anesthesia. There was no significant difference between both groups regarding early failure of AVF (Group 1, 14% vs. Group2; 11%. P= 0.80). No significant advantage of regional over general anesthesia in terms of early outcome of AVF was seen in this study.
Department of Surgery, King Faisal University, Al-Khobar, Saudi Arabia. elsharawya@yahoo.co.uk
Mohamed A
MA
Elsharawy
Roshdi
R
Al-Metwalli
D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001917:Brachial Plexus; D004550:Elbow / Q000098:blood supply*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects; D011446:Prospective Studies; D006435:Renal Dialysis; D012529:Saudi Arabia; D016896:Treatment Outcome; D055815:Young Adult