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World J Crit Care Med. Mar 9, 2025; 14(1): 100503
Published online Mar 9, 2025. doi: 10.5492/wjccm.v14.i1.100503
Anaesthesia in chronic dialysis patients: A narrative review
Julian Yaxley
Julian Yaxley, Department of Medicine, Queensland Health, Meadowbrook 4131, Qld, Australia
Author contributions: Yaxley J was the sole contributor, wrote the article.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Julian Yaxley, FRACP, Doctor, Department of Medicine, Queensland Health, Loganlea Rd, Meadowbrook 4131, Qld, Australia. julian.yaxley@gmail.com
Received: August 18, 2024
Revised: October 27, 2024
Accepted: November 12, 2024
Published online: March 9, 2025
Processing time: 114 Days and 23.7 Hours
Abstract

The provision of anaesthesia for individuals receiving chronic dialysis can be challenging. Sedation and anaesthesia are frequently managed by critical care clinicians in the intensive care unit or operating room. This narrative review summarizes the important principles of sedation and anaesthesia for individuals on long-term dialysis, with reference to the best available evidence. Topics covered include the pharmacology of anaesthetic agents, the impacts of patient characteristics upon the pre-anaesthetic assessment and critical illness, and the fundamentals of dialysis access procedures.

Keywords: Dialysis; Sedation; Critical care; Anaesthesia; Intensive care; Pharmacology; Renal impairment

Core Tip: Patients on chronic dialysis have increased perioperative and anaesthetic risks. Sedative and analgesic agents must be titrated appropriately. The optimal blood pressure targets are unknown but may be higher than for the general population. Caution is necessary with electrolyte and fluid management. A detailed pre-anaesthesia evaluation is particularly important in this patient group.