Blok Aksilar pada Pasien Pseudoaneurisma pada Antebrakii Sinistra yang Disertai Gagal Ginjal Terminal

Patients with end stage renal disease on hemodialysis often developed pseudoaneurysm in the artery venous shunt area. End stage renal disease is a multisystem disease. Most drugs were excreted through the kidney and most anesthesia drugs have the potential in reducing renal blood flow, glomerular filtration rate and urine production. Axilary block is one of the plexus brachialis block commonly used and provide excellent blockade for under elbow procedures. A 62 year old woman with pseudoaneurysm in the right wrist underwent artery venous shunt procedure for hemodialysis. In this patient, hematoma evacuation was performed and left artery radial was ligated under axilary block anesthesia at Dr. Hasan Sadikin General Hospital Bandung August, 2012. Patient was alert with blood pressure 170/80 mmHg, pulse rate 85x/minutes and oxygen saturation 96% on free air. The procedure was performed within about one and half hour, and patient was stable. Anesthesia management in end stage renal disease patient requires an understanding of< the pathological changes accompany renal disease, other medical conditions and pharmacokinetics of the used drugs. Optimal management was done to minimalize kidney damage occured previously.