Optimal time for spinal in dialysis patients?

[sigrhoillusion]

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Is there any consensus on the best time to perform a spinal on patients on HD? Assuming coagulation and electrolytes are normal regardless of timing. I tried to look up papers but couldn't find anything concrete. Some papers showed increase morbidity in patients undergoing GA immediately after HD but couldn't find anything about regional.

It seems that these patients get hypotensive under spinal regardless of timing. So anytime believe it's better right before or after, or maybe day before or after?

Running a phenylephrine infusion 9n a hypivolemic hypotensive patient isn't ideal although you don't have to worry about knocking off their kidneys. Obviously perfusion to the head and heart is important too... PreHD you might not have as much vasoplegia but then you also have less window for fluid administration before volume overload and pulmonary edema might become an issue.

So anyone have any personal opinions? Or does it not really matter?

 

[nimbus]

What’s wrong with a phenylephrine infusion?

 

[deleted131481]

I'd rather do post-dialysis whether spinal or GA. Can easily correct hypovolemia, less easy to correct coags/lytes.

 

[fakin' the funk]

Is there any consensus on the best time to perform a spinal on patients on HD? Assuming coagulation and electrolytes are normal regardless of timing. I tried to look up papers but couldn't find anything concrete. Some papers showed increase morbidity in patients undergoing GA immediately after HD but couldn't find anything about regional.

It seems that these patients get hypotensive under spinal regardless of timing. So anytime believe it's better right before or after, or maybe day before or after?

Running a phenylephrine infusion 9n a hypivolemic hypotensive patient isn't ideal although you don't have to worry about knocking off their kidneys. Obviously perfusion to the head and heart is important too... PreHD you might not have as much vasoplegia but then you also have less window for fluid administration before volume overload and pulmonary edema might become an issue.

So anyone have any personal opinions? Or does it not really matter?

a) no consensus but the best answer is "1 day after HD"
b) depends on the case don't it
c) what's wrong with phenylephrine
d) don't run phenylephrine as first line if your pt is hypovolemic, which in your example they are

 

[coffeebythelake]

I tried to look up papers but couldn't find anything concrete. Some papers showed increase morbidity in patients undergoing GA immediately after HD but couldn't find anything about regional.

What studies are you referring to

 

[GassYous]

What’s wrong with a phenylephrine infusion?

It's a pita to set up for a short case

 

[Ronin786]

It's a pita to set up for a short case

You guys don't have pre-made syringes? Just squirt a bunch of them into the LR bag.

 

[Mman]

So anyone have any personal opinions? Or does it not really matter?

I have very little ability to influence the timing of the surgery in relation to dialysis for the overwhelming majority of ESRD patients I see. We just want them kept on their normal schedule (don't show up for Thursday surgery having skipped normal Wednesday HD).

 

[GassYous]

You guys don't have pre-made syringes? Just squirt a bunch of them into the LR bag.

That's more work than I'm willing to do.