2015年4月6日星期一

Spinal Anaesthesia for Patients with Renal Failure

Renal Failure patients have a longer life span than they did decades ago due to continuing refinements in dialysis and kidney transplant. Consequently, anaesthetists provide care for these patients with increased frequency, for various surgical procedures. Here, we mainly talk about spinal anaesthesia and Renal Failure.

Introduction

Spinal anaesthesia is induced by injecting small quantity of local anaesthetic into the cerebro-spinal fluid (CSF). The infection is often made in the lumbar spine below the level at which the spinal cord ends (L2). It is easy to perform and has the potential to provide excellent operating conditions for surgery below the umbilicus.

Most patients with Renal Failure are aware of the chronic nature of the disease and its severe prognosis. They have possibly receive surgery on many occasions, and many patients will undergo this anaesthesia.

Potential limitations in the consideration of spinal anaesthesia

1. Bleeding tendency. This could theoretically be a problem due to the risk of haematoma formation. But, for people on adequate dialysis, the primary platelet dysfunction can be reversed. With normal coagulation screen and bleeding time, there should be objection to the application of spinal techniques.

2. Sympathetic blockade. It is an important consideration when utilizing the technique. A high level of blockade can result in a significant drop in blood pressure and glomerular filtration rate (GFR).

3. Severe hypertension. Patients with severe high blood pressure should avoid this anaesthesia.

4. Inadequate duration and poor patient acceptance can lead to unsatisfactory techniques for prolonged procedure.

5. Uraemic neuropathy. The use of this technique is controversial for those patients.

6. Metabolic acidosis. Acidosis can reduce the central nervous system threshold to the toxic effects of local anaesthesia, so the total dose of anaesthetic should be decreased by about 25% in the acidotic patient.


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