How often to you bend other guidelines?

[Planktonmd]

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I believe so. I'm too lazy to dig it up for you, though.

I highly doubt that there is any data showing equal outcomes between GA and regional anesthesia in ESRD patients for vascular access procedures.
So until you find such data your argument is invalid, and I repeat that in my practice I see way more immediate intra-op and post-op complications when GA or MAC are used.

 

[deleted162650]

Maybe you're just not doing it right??😛

 

[Ignatius J]

You don't agree that the tissue trauma is the same? If there was a decreased incidence of postop MI with regional for those cases, we'd have seen it already in large studies.

Studies have shown different levels of cytokine release based on anesthetic technique, which would explain my disagreement. And again, I think it's a bigger risk to leave a catheter on this guy's neck for longer than it needs to be. I reckon sepsis would not treat him well. This is a case to think like a doctor and not a nurse. Protocols and guidelines do have exceptions. Reality is he is probably more likely to have an MI during dialysis than he would for an AVF with a supraclavicular block.