In the anesthetic management of a hemodialysis dependent patient undergoing aortic valve replacement, technical and pathophysiologic problems considered included: the presence of an arteriovenous hemodialysis fistula; hemodynamic alterations associated with aortic insufficiency; choice of anesthetic agents, fluid, and electrolyte balance in the presence of renal failure; and postoperative management of hypertension and hyperkalemia. While there are many possible approaches, one successful technic is presented.
