A patient with end-stage renal disease receives maintenance haemodialysis on Monday, Wednesday and Friday mornings. Elective total knee replacement is being planned. When should the operation ideally be scheduled?
- A Immediately after a dialysis session on the same day
- B Just before the next scheduled dialysis session
- C The morning after a dialysis session ✓
- D Any day, because timing relative to dialysis does not matter
Explanation
Scheduling surgery the day after haemodialysis balances competing concerns. By then, the residual vasodilation and relative hypovolaemia of the immediate post-dialysis period have settled, and the anticoagulant effect of dialysis heparin has waned, reducing bleeding risk. At the same time, the interval is short enough that significant interdialytic accumulation of fluid, potassium and uraemic toxins has not yet occurred. Operating immediately after dialysis invites hypotension during induction, and waiting until late in the interdialytic interval invites hyperkalaemia.
Reference: Morgan and Mikhail's Clinical Anesthesiology, 7th ed.
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