Muhammad Saleh Waryam, Rehman Zia U, Hashmi Shiraz
Section of Vascular Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, PAK.
Department of Vascular and Endovascular Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, PAK.
Cureus. 2021 Aug 8;13(8):e16991. doi: 10.7759/cureus.16991. eCollection 2021 Aug.
Background Basilic transposition arteriovenous fistula (BT AVF) is a viable option for dialysis-dependent patients, which can be performed under either general or regional anesthesia. Regional anesthesia is reported to cause vascular dilatation during the perioperative period, leading to improved fistula success. Regional anesthesia is also considered safe as compared to general anesthesia in terms of hemodynamic stability. Limited and conflicting data are available comparing regional versus general anesthesia in terms of fistula maturation and patency. We aimed to compare the maturation, one-year patency rates, and complication rates in patients undergoing single-stage BT AVF in regional versus general anesthesia. Methods This retrospective observational study was conducted on patients undergoing single-stage BT AVF from January 2016 to December 2019. Patients were divided into regional (RA) vs. general anesthesia (GA) groups and compared in terms of maturation, one-year patency, and perioperative complication rates. Results Out of 152 patients, 110 (72.37%) were in GA while 42 (27.63%) were in the RA group. Elderly, female, diabetic, ischemic heart disease, and American Society of Anesthesiologists (ASA) class IV patients were more in the RA group. Other comorbid and vascular access-related factors were comparable between the groups. A trend toward higher maturation rates (97.6% vs. 92.1%) and one-year patency rates (62.5% vs. 56.6%) was observed in the RA vs. GA group, however, the difference did not attain statistical significance, p=0.359 and p=0.327, respectively. The rate of access abandonment was higher in the GA group (43.4% vs. 37.5%). The most prevalent cause of abandonment was death in the RA group while it was access failure in the GA group. Overall complication rates were comparable between both groups (20.2 % vs. 17.5%, p=0.816). Conclusion Regional anesthesia is a useful technique with potentially improved maturation and patency rates. Nevertheless, an assumed benefit of regional anesthesia in terms of anesthesia-related complications was not observed.
贵要静脉转位动静脉内瘘（BT AVF）是依赖透析患者的一种可行选择，可在全身麻醉或区域麻醉下进行。据报道，区域麻醉在围手术期会导致血管扩张，从而提高内瘘成功率。就血流动力学稳定性而言，区域麻醉与全身麻醉相比也被认为是安全的。关于区域麻醉与全身麻醉在内瘘成熟度和通畅率方面的比较，现有数据有限且相互矛盾。我们旨在比较接受单阶段BT AVF的患者在区域麻醉与全身麻醉下的成熟度、一年通畅率和并发症发生率。
本回顾性观察性研究针对2016年1月至2019年12月期间接受单阶段BT AVF的患者进行。将患者分为区域麻醉（RA）组和全身麻醉（GA）组，并在成熟度、一年通畅率和围手术期并发症发生率方面进行比较。
152例患者中，110例（72.37%）接受全身麻醉，42例（27.63%）接受区域麻醉。区域麻醉组中老年、女性、糖尿病、缺血性心脏病患者及美国麻醉医师协会（ASA）分级为IV级的患者更多。两组之间的其他合并症和血管通路相关因素具有可比性。区域麻醉组与全身麻醉组相比观察到成熟率（97.6%对92.1%）和一年通畅率（62.5%对56.6%）有升高趋势，但差异无统计学意义，p值分别为0.359和0.327。全身麻醉组的通路废弃率更高（43.4%对37.5%）。区域麻醉组废弃的最常见原因是死亡，而全身麻醉组是通路失败。两组的总体并发症发生率相当（20.2%对17.5%，p = 0.816）。
区域麻醉是一种有用的技术，可能会提高成熟度和通畅率。然而，未观察到区域麻醉在麻醉相关并发症方面的假定益处。
