Issues to address:
1. Should the patient have the surgery? Risk estimation and discussion of pros/cons/risks/benefits of having surgery vs not having surgery.
1. If the patient is to have surgery, how can they be optimised?
2. If the patient is to have surgery, planning and discussion of the anaesthetic technique and peri-op care.
High risk if:
Previous cardiac event
Severe degree of disease (LVF, sever AS)
Most cadiac morbidity is acquired disease.
High index of suspicion if:
Cardiac risk factors (FHx, smoking, age, HTN, DM)
Chest pain requiring opioids
Ix: ECG, CXR, Serial troponin, echo, CTPA
From Obstetric Revalidation Day
Chronic Renal Impairment – mild.
Treat as normal
Chronic Renal Impairment – severe
Dialyse on morning
Timing of anticoagulation. Consider plt dysfunction for regional. COnsider difficult airway and aspiration risk for GA
Avoid invasive monitoring (risk of infection) and protect AV fistula
Consider altering surgical incision
Avoid hypotension & hypertension