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Renal Disease Preoperative Care
Aka: Renal Disease Preoperative Care, Preoperative Evaluation in Kidney Disease
- 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)
- 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
- Aspirin
- Dipyridamole (Persantine)
- Avoid other agents with increased bleeding risk
- Diphenhydramine
- NSAIDs
- Chlordiazepoxide
- Cimetidine
- Anemia
- Consider Erythropoietin several weeks before surgery
- Consider correcting Hematocrit below 27%
- Antibiotic prophylaxis
- Empiric prophylaxis: Cefazolin (Ancef)
- Cardiac Risk
- See Preoperative Cardiovascular Evaluation
- 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
- References
- Krishnan (2002) Am Fam Physician 66(8):1471-6 [PubMed]