title: General anesthesia soon after dialysis may increase postoperative hypotension - A pilot study.
abstract: BACKGROUND
  Pilot study associating hemodialysis-to-general-anesthesia time interval and post-operative complications in hemodialysis patients to better define a more optimal pre-anesthetic waiting period.
  
  
  METHODS
  Pre-anesthetic and 48-hours post-anesthetic parameters (age, gender, body-mass-index, pre-operative ultrafiltrate, potassium, renal disease etiology, hemodialysis sessions per week, Acute Physiology and Chronic Health Evaluation-II score, Portsmouth-Physiologic and Operative Severity Score for the Enumeration of Mortality and Morbidity, American Society of Anesthesiologists physical status, Johns Hopkins Surgical Classification System Category, surgical urgency, intra-operative fluids, estimated blood loss, post-operative complications) were collected on chronic hemodialysis patients between 11/2009-12/2010. Continuous data were analyzed by Analysis of Variance or t-test. Bivariate data were analyzed by Fisher's Exact Test. Relative Risks/Confidence Intervals were calculated for statistically significant comparisons (p=0.05). Exclusion criteria were incomplete records, peritoneal dialysis, intra-operative hemodialysis, liver transplant, and cardiopulmonary bypass.
  
  
  RESULTS
  Patients were grouped by dialysis to anesthesia time interval: Group 1 >24 hours, Group 2 7-23.9 hours, Group 3 < 7 hours. Among Surgical Category 3-5 patients, hypotension was more common in Group 3 than Group 1 (63.6% vs 9.2%, p<0.0001, relative risk=6.9, confidence interval=3.0-15.7) or Group 2 (63.6% vs 17.3%, p=0.0002, relative risk=3.7, confidence interval=1.9-7.2). Other complications rates were not statistically significant. Disease and surgical severity scores, preoperative ultrafiltrate, and intra-operative fluids were not different.
  
  
  CONCLUSIONS
  Post-anesthetic hypotension within 48 hours was more common in those with < 7 hours interval between dialysis and anesthesia. Therefore, if surgical urgency permits, a delay of ≥7 hours may limit postoperative hypotension. More precise associations should be obtained through a prospective study.
authors.affiliation: Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California, USA ; Center for Critical Care, Loma Linda University Medical Center, Loma Linda, California, USA.
authors.forename: J
authors.initials: J
authors.lastname: Deng
authors.affiliation: Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California, USA.
authors.forename: J
authors.initials: J
authors.lastname: Lenart
authors.affiliation: Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Applegate
keywords: anesthesia; complications; dialysis; general; hypotension; interval; post-operative; surgery; time; ultrafiltrate