Nephrology Book

Organ Failure

  • Renal Disease Preoperative Care

//fpnotebook.com/

Renal Disease Preoperative Care

Aka: Renal Disease Preoperative Care, Preoperative Evaluation in Kidney Disease
  1. Diagnostics (Preoperative)
    1. Chemistry panel (repeat within 3 hours of surgery)
    2. Complete Blood Count
    3. Other tests to consider
      1. Arterial Blood Gas (if bicarbonate < 18 meq/L)
      2. Bleeding Time (if suspect uremic bleeding risk)
  2. Special concerns in Renal Failure
    1. Hyperkalemia (Serum Potassium > 5.5 mmol/L)
      1. Consider avoiding general anesthesia
      2. Consider Hyperkalemia Management
    2. Metabolic Acidosis
      1. Reduces Local Anesthesia effect
    3. Bleeding risk
      1. Decrease Uremia (Dialysis on day prior to surgery)
      2. Correct Bleeding Times over 10 minutes
      3. Avoid surgery within 12 hours of Heparinized Dialysis
      4. Avoid antiplatelet agents within 72 hours of surgery
        1. Aspirin
        2. Dipyridamole (Persantine)
      5. Avoid other agents with increased bleeding risk
        1. Diphenhydramine
        2. NSAIDs
        3. Chlordiazepoxide
        4. Cimetidine
    4. Anemia
      1. Consider Erythropoietin several weeks before surgery
      2. Consider correcting Hematocrit below 27%
    5. Antibiotic prophylaxis
      1. Empiric prophylaxis: Cefazolin (Ancef)
    6. Cardiac Risk
      1. See Preoperative Cardiovascular Evaluation
    7. Hypertension
      1. Continue home antihypertensive agents perioperatively
        1. Convert oral agents to intravenous equivalents
      2. Consider transdermal Clonidine
        1. Replaces agents without intravenous equivalent
        2. Start several days before surgery
      3. Consider stopping Diuretics before surgery
  3. References
    1. Krishnan (2002) Am Fam Physician 66(8):1471-6 [PubMed]

You are currently viewing the original 'fpnotebook.com\legacy' version of this website. Internet Explorer 8.0 and older will automatically be redirected to this legacy version.

If you are using a modern web browser, you may instead navigate to the newer desktop version of fpnotebook. Another, mobile version is also available which should function on both newer and older web browsers.

Please Contact Me as you run across problems with any of these versions on the website.

Navigation Tree