II. Diagnostics (Preoperative)
- Chemistry panel (repeat within 3 hours of surgery)
- Complete Blood Count
- Other tests to consider
- Arterial Blood Gas (if bicarbonate < 18 meq/L)
- Bleeding Time (if suspect uremic bleeding risk)
III. Special concerns in Renal Failure
-
Hyperkalemia (Serum Potassium > 5.5 mmol/L)
- Consider avoiding general Anesthesia
- Consider Hyperkalemia Management
-
Metabolic Acidosis
- Reduces Local Anesthesia effect
- Bleeding risk
- Decrease Uremia (Dialysis on day prior to surgery)
- Correct Bleeding Times over 10 minutes
- Avoid surgery within 12 hours of Heparinized Dialysis
- Avoid antiplatelet agents within 72 hours of surgery
- Avoid other agents with increased bleeding risk
-
Anemia
- Consider Erythropoietin several weeks before surgery
- Consider correcting Hematocrit below 27%
- Antibiotic prophylaxis
- Cardiac Risk
-
Hypertension
- Continue home Antihypertensive agents perioperatively
- Convert oral agents to intravenous equivalents
- Consider transdermal Clonidine
- Replaces agents without intravenous equivalent
- Start several days before surgery
- Consider stopping Diuretics before surgery
- Continue home Antihypertensive agents perioperatively