Anaesthesia for renal failure and dialysis

Model answer

Optimisation (3). Volume status vs dry weight, ECG, urgent U&E/K+, comorbidity review, blood products if needed; involve nephrology early — emergency may not allow full HD first but K+ must be addressed.^[2][4]

Potassium (4). Treat ECG-changing hyperkalaemia with calcium then insulin–glucose/salbutamol/acidosis correction; arrange urgent post-op dialysis; avoid suxamethonium if K+ high.^[3]

Drugs & technique (4). Titrate induction; prefer cisatracurium or reduced rocuronium + quantitative NMM; avoid morphine/pethidine; fentanyl/remifentanil; vasopressors ready; restrictive fluids.^[1]

Fistula & postop (4). No cuff/IV/art line on left arm; protect thrill; HDU; early HD for K+/volume; renally adjusted VTE prophylaxis.^[2]