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Regional anesthesia for vascular access surgery.

Publication ,  Journal Article
Malinzak, EB; Gan, TJ
Published in: Anesth Analg
September 2009

BACKGROUND: Approximately 25% of initial arteriovenous fistula (AVF) placements will fail as a result of thrombosis or failure to develop adequate vessel size and blood flow. Fistula maturation is impacted by patient characteristics and surgical technique, but both increased vein diameter and high fistula blood flow rates are the most important predictors of successful AVFs. Anesthetic techniques used in vascular access surgery (monitored anesthesia care, regional blocks, and general anesthesia) may affect these characteristics and fistula failure. METHODS: We performed a literature search using key words in the PubMed/MEDLINE database. Seven articles that related to the effects of anesthesia on AVF construction, including sympathetic block, vein dilation, blood flow, adverse outcomes, or patency rates, comprised the sources for this review. RESULTS: Significant vasodilation after regional block administration is seen in both the cephalic and basilic veins. These vasodilatory properties may assist with AVF site selection. In the intraoperative and postoperative periods, use of a regional block, compared with other anesthetic techniques, resulted in significantly increased fistula blood flow. The greater sympathetic block contributed to vessel dilation and reduced vasospasm. Use of regional techniques in AVF construction yielded shorter maturation times, lower failure rates, and higher patency rates. CONCLUSION: Use of regional blocks may improve the success of vascular access procedures by producing significant vasodilatation, greater fistula blood flow, sympathectomy-like effects, and decreased maturation time. However, a large-scale, prospective, clinical trial comparing the different anesthetic techniques is still needed to verify these findings.

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Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

September 2009

Volume

109

Issue

3

Start / End Page

976 / 980

Location

United States

Related Subject Headings

  • Vasodilation
  • Vascular Surgical Procedures
  • Treatment Outcome
  • Thrombosis
  • Risk Factors
  • Regional Blood Flow
  • Kidney Failure, Chronic
  • Humans
  • Arteriovenous Shunt, Surgical
  • Anesthesiology
 

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Malinzak, E. B., & Gan, T. J. (2009). Regional anesthesia for vascular access surgery. Anesth Analg, 109(3), 976–980. https://doi.org/10.1213/ane.0b013e3181adc208
Malinzak, Elizabeth B., and Tong J. Gan. “Regional anesthesia for vascular access surgery.Anesth Analg 109, no. 3 (September 2009): 976–80. https://doi.org/10.1213/ane.0b013e3181adc208.
Malinzak EB, Gan TJ. Regional anesthesia for vascular access surgery. Anesth Analg. 2009 Sep;109(3):976–80.
Malinzak, Elizabeth B., and Tong J. Gan. “Regional anesthesia for vascular access surgery.Anesth Analg, vol. 109, no. 3, Sept. 2009, pp. 976–80. Pubmed, doi:10.1213/ane.0b013e3181adc208.
Malinzak EB, Gan TJ. Regional anesthesia for vascular access surgery. Anesth Analg. 2009 Sep;109(3):976–980.

Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

September 2009

Volume

109

Issue

3

Start / End Page

976 / 980

Location

United States

Related Subject Headings

  • Vasodilation
  • Vascular Surgical Procedures
  • Treatment Outcome
  • Thrombosis
  • Risk Factors
  • Regional Blood Flow
  • Kidney Failure, Chronic
  • Humans
  • Arteriovenous Shunt, Surgical
  • Anesthesiology