The importance of anesthesiological methods in the creation of arteriovenous fistulas

All anesthesia procedures represent a real danger to life in patients with renal insufficiency, which is why these patients are classified in category IV, so anesthesia procedures for this population are adjusted depending on their individual characteristics. Although local and general anesthesia are acceptable modalities for arteriovenous fistula formation, it is known that local anesthesia is associated with tissue reduction and edema, which may be associated with reduced electrocautery efficiency, increased risk of infection, and vasospasm, especially with repeated injections. It must be noted that there is no consensus on whether an arteriovenous fistula should be created under local, regional, or general anesthesia. Still, it is considered that regional block anesthesia provides reduced vasospasm of blood vessels, provokes venodilatation and complete sensory and blockade of motor neurons, as well as higher primary functional rates in the first 3 months, since its creation, compared with local anesthesia. Overall, patients with end-stage renal disease are a group of patients with a wide range of comorbidities which, along with chronic kidney damage, increase the risk of perioperative anesthetic complications, especially when subjected to general anesthesia. Therefore, alternative modes of anesthesia, such as local and regional blockade, could bring obvious benefits to these patients. It can be concluded that the choice of anesthesia method is determined by several interrelated factors, anesthesiologist, patient and the surgeon, which implies expertise, inclination, habits, practicality, and norms.