Anaesthesia in Renal Disease

Question 1

What are the 5 principles of management for anaesthesia in acute kidney injury (and CKD)

Answer 1

1. Avoid nephrotoxins (NSAIDS/aminoglycosides)
2. Use renal adjusted doses
3. Tight fluid balance
4. Awareness electrolyte derangement
5. Early consideration for dialysis

Question 2

What are the key aspects of an anaesthetic for a patient with CKD

Answer 2

ALWAYS PROTECT THE FISTULA
- BP cuffs and IV lines on contralateral side

1. Airway: uraemic gastropathy –> delayed gastric emptying
2. Breathing: Fluid balance –> fluid status swings are dramatic and depend on the proximity to last dialysis
3. Circulation: Atherosclerosis increased in CKD
4. Delivery (O2): Anaemia is common but well tolerated
5. Electrolyte disturbance is common