Surgery after dialysis

[BeatriZZ]

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Do any of you take patients for elective surgery right after dialysis? I'm talking patient being wheeled right from dialysis to pre-op holding area. A former colleague of mine is at an institution that enforces a waiting period of 6 hours...I found 1 paper that suggested more hypotension with general anes <7 hours after dialysis but what if its a MAC or regional case?

 

[facted]

Do any of you take patients for elective surgery right after dialysis? I'm talking patient being wheeled right from dialysis to pre-op holding area. A former colleague of mine is at an institution that enforces a waiting period of 6 hours...I found 1 paper that suggested more hypotension with general anes <7 hours after dialysis but what if its a MAC or regional case?

Not only would I wait, I would require post dialysis lytes. Do not assume they fixed it all up. I've seen hyperkalemia after dialysis that was worse than before they went in.

Volume is certainly an issue as well. Ideally the case should be done on the next day after dialysis, though not a big deal for a small case as much.

 

[psychbender]

Depends on the case and why it needs to go, but yes, I've taken patients straight from dialysis to the OR. They're usually a touch on the dry side, so handle with care.

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[anbuitachi]

yea straight from dialysis to holding area for preop to OR

 

[Gas you down]

no dialysis before elective surgery/procedure unless run even...i.e. not much fluid taken off. prefer do cases on off days.
even applies to some mac cases, like colonoscopies since they also get the prep which dehydrates them some.

but use your clinical judgement if it's in the patients overall best interest

 

[aneftp]

We prefer them have dialysis the day before surgery. They tend to be in the dry side so hypotension is a concern. Yeah. 6 hours min with the other institution you mention sound correct. But since many dialysis patients have dialysis anyway from 9am-1pm. It takes 3 hours for dialysis. And than making them wait 6 hours after dialysis. That takes their surgery time to 6-9pm. So that's why easier to just say dialysis day before surgery.

There are exceptions of course. Minor cases we can fudge it. But someone have a major elective surgical case. Best to wait and have them schedule dislysis day before surgery.