title: Dialysis Access Surgery: Does Anesthesia Type Affect Maturation and Complication Rates?
abstract: BACKGROUND
  Creation of an arteriovenous fistula (AVF) is the preferred method of establishing long-term dialysis access. There are multiple anesthetic techniques used for patients undergoing this surgery including general endotracheal intubation, laryngeal mask airway, regional anesthesia with nerve blocks, and monitored anesthesia care with local infiltration. It is unclear what effect the method of anesthesia has on AVF creation success rate. It is our objective to determine if anesthesia type affects success of these surgeries defined by complication and maturation rates.
  
  
  METHODS
  A retrospective review was performed in a single institution, single surgeon study of 253 patients who underwent AVF creation between January 2003 and December 2010. Patients were cross analyzed between 3 anesthesia types (General Endotracheal Intubation, Laryngeal Mask Airway and Local Infiltration with Monitored Anesthesia Care) and AVF creation surgeries (radiocephalic, brachiocephalic, and basilic vein transposition). No patients had regional anesthesia performed. Demographic data including comorbidities and risk factors were stratified among all categories. Analysis of variance, chi-squared testing, and Fisher's exact P testing was performed across all anesthesia types and specific operations and measured according to success of fistula maturation and complication rates (including death within 30 days, myocardial infarction within 30 days, respiratory insufficiency, venous hypertension, wound infections, neuropathy, and vascular steal syndrome).
  
  
  RESULTS
  There were no significant differences in maturation rate in terms of all 3 anesthesia types for radiocephalic (P = 0.191), brachiocephalic (P = 0.191), and basilic vein transposition surgeries (P = 0.305). In addition, there were no differences in complication rates between the surgeries and the 3 types of anesthesia (P = 0.557).
  
  
  CONCLUSIONS
  Our study shows that despite anesthesia type, outcomes in terms of maturation and complication rate are not statistically different in AVF creation surgeries. The use of monitored anesthesia care with local anesthesia may improve operative efficiency in terms of time in the operating room and in the recovery unit and therefore may be the preferred method of anesthesia. This recommendation may also parallel the preference to avoid general anesthesia in a patient population with more medical comorbidities. It is our conclusion that dialysis access surgery should therefore be performed under local anesthesia with monitored anesthesia care.
authors.affiliation: Division of Vascular and Endovascular Surgery, Riverside Department of Surgery, University of California, Riverside County Regional Medical Center, Moreno Valley, CA. Electronic address: Andrew.Son@ucr.edu.
authors.forename: Andrew
authors.initials: A
authors.lastname: Son
authors.affiliation: Division of Vascular and Endovascular Surgery, Riverside Department of Surgery, University of California, Riverside County Regional Medical Center, Moreno Valley, CA.
authors.forename: Kristyn
authors.initials: K
authors.lastname: Mannoia
authors.affiliation: Division of Vascular and Endovascular Surgery, Riverside Department of Surgery, University of California, Riverside County Regional Medical Center, Moreno Valley, CA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Herrera
authors.affiliation: Division of Vascular and Endovascular Surgery, Riverside Department of Surgery, University of California, Riverside County Regional Medical Center, Moreno Valley, CA.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Chizari
authors.affiliation: Division of Vascular and Endovascular Surgery, Riverside Department of Surgery, University of California, Riverside County Regional Medical Center, Moreno Valley, CA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Hagdoost
authors.affiliation: Division of Vascular and Endovascular Surgery, Riverside Department of Surgery, University of California, Riverside County Regional Medical Center, Moreno Valley, CA.
authors.forename: Afshin
authors.initials: A
authors.lastname: Molkara
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D000772:Anesthesia, Local / Q000009:adverse effects; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome