Most procedures to create hemodialysis access are outpatient procedures with patients arriving 1–2 h prior to the planned procedure start. The preanesthesia interview in the preoperative holding area is one of the most important phases in preparing the patient for the administration of anesthesia. The anesthesia team should review the preanesthesia evaluation completed in the preanesthesia clinic and confirm that the patient’s general condition has not changed since the preanesthesia clinic evaluation. Intravenous access and blood pressure monitoring should be avoided in the arteriovenous (AV) access arm. Obtaining peripheral venous access may be difficult, and SonoSite may be necessary to identify and guide access. In those patients with an indwelling catheter, it may be accessed, although this is avoided in general due to fear of increased infectious complications.

In patients with CKD who are not yet on hemodialysis, it is important to elicit information regarding the volume and regularity of urine production with special attention to those who report a recent drop in volume or frequency. This may indicate a recent worsening of their renal function which may necessitate closer attention to potassium changes or fluid management during the procedure. For patients with ESRD on dialysis, it is important to establish when the patient underwent dialysis last. Ideally, the patient should have hemodialysis 12–24 h prior to the procedure, as the patient should ideally be completely or near completely at a normal physiological status and baseline dry weight at the time of anesthetic administration and the procedure. Close attention should be paid to establishing the correct “dry weight” for the patient, i.e., the weight at which they are euvolemic. If the patient is above their dry weight preoperatively, they risk pulmonary edema and poorly controlled hypertension perioperatively. If under their dry weight, they may become profoundly hypotensive during anesthesia [4]. Additionally, the regularity at which the patient has recently undergone dialysis is also important because a single session of dialysis may not normalize the patient that has missed more than one session, particularly with regard to fluid status. Similarly, it is important to ask if the patient tolerated the last hemodialysis session. If the patient did not tolerate the last hemodialysis session, the session was terminated prematurely or the patient skipped a regular session because of feeling ill; this warrants further investigation along with an assessment of laboratory abnormalities that may necessitate canceling or rescheduling the procedure.

Verification of certain laboratory data is critical to check on the day of the procedure as these patients are subject to day-to-day changes.