Implantation of a peritoneal dialysis catheter in patients with ESRD using local anesthesia and Remifentanil

• Published in: PloS one Vol. 16; no. 11; p. e0259351
• Main Authors: Jabbour, Elizabeth, Fütterer, Carsten, Zach, Sebastian, Kälsch, Anna-Isabelle, Keese, Michael, Rahbari, Nuh N., Krämer, Bernhard K., Schwenke, Kay G.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 04.11.2021; Public Library of Science (PLoS)
• Subjects: Abdomen; Abdominal surgery; Adult; Aged; Aged, 80 and over; Anesthesia; Biology and Life Sciences; Care and treatment; Catheterization - adverse effects; Catheterization - methods; Catheters; Chronic kidney failure; Complications and side effects; Consent; Continuous ambulatory peritoneal dialysis; Diagnosis; Dialysis; Dosage and administration; Drug dosages; End-stage renal disease; Engineering and Technology; Feasibility Studies; Female; General anesthesia; Health risks; Humans; Insertion; Kidney diseases; Kidney Failure, Chronic - therapy; Local anesthesia; Male; Medical instruments; Medicine and Health Sciences; Mepivacaine - administration & dosage; Mepivacaine - adverse effects; Methods; Middle Aged; Patient outcomes; Patients; Peritoneal dialysis; Peritoneal Dialysis - adverse effects; Peritoneal Dialysis - instrumentation; Peritoneum; Prospective Studies; Remifentanil; Remifentanil - administration & dosage; Remifentanil - adverse effects; Renal replacement therapy; Surgeons; Treatment Outcome; Urinary catheterization; Vascular surgery; Germany
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0259351

The main objective of this study is to test the feasibility of the local anesthetic (LA) Mepivacaine 1% and sedation with Remifentanil as the primary anesthetic technique for the insertion of a peritoneal dialysis (PD) catheter, without the need to convert to general anesthesia. We analyzed 27 consecutive end-stage renal disease (ESRD) patients who underwent the placement of a peritoneal catheter at our center between March 2015 and January 2019. The procedures were all performed by a general or vascular surgeon, and the postoperative care and follow-up were all conducted by the same peritoneal dialysis team. All of the 27 subjects successfully underwent the procedure without the need of conversion to general anesthesia. The catheter was deemed prone to usage in all patients and was found to be leak-proof in 100% of the patients. This study describes a safe and successful approach for insertion of a PD catheter by combined infiltration of the local anesthetic Mepivacaine 1% and sedation with Remifentanil. Hereby, ESRD patients can be treated without general anesthesia, while ensuring functionality of the PD catheter.