Abstract
With an increasing number of hemodialysis patients, surgery on hemodialysis patients is also increasing. From an anesthetic perspective, chronic renal failure patients on hemodialysis belong to a high risk group. However, there are no statistical data on anesthesia-related critical incidents among this group. We investigated the morbidity, mortality and etiology of critical incidents (cardiac arrest/other critical events such as serious hypotension, serious hypoxemia and serious bradycardia) during anesthesia among 998 chronic renal failure patients on hemodialysis. Based on ASA physical status (ASA-PS), the numbers of the patients in ASA-PS 3, 3E, 4, 4E were 895 (89.7%), 72 (7.2%), 13 (1.3%), 18 (1.8%), respectively.
Critical incidents occurred to 30 patients, and 11 of them died during anesthesia or within 7 postoperative days. The morbidity and mortality rates of critical incidents (per 1,000 cases of anesthesia) were 30 and 11, respectively. Cardiac arrest occurred to 3 patients. The incidence of cardiac arrest was 3 per 1,000 cases of anesthesia.
Etiologies of critical incidents were preoperative complications in 23 cases (76.7%), and anesthetic management in 7 cases (23.3%). The major preoperative complication related to critical incidents was cardiac failure, followed by sepsis. The most frequent problem of anesthetic management was regional anesthesia such as spinal anesthesia or epidural anesthesia. The incidence of critical events was higher in the patients with ASA-PS 4 and 4E than in those with ASA-PS 3 and 3E. ASA-PS correlated with incidences of critical events in hemodialysis patients.
We conclude that hemodialysis patients should be considered high risk group for anesthesia. Furthermore, preanesthetic assessment and preparation are essential for the safety of anesthetic management.
