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.
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
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
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
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
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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