Nephrology Book

Organ Failure

  • Renal Disease Preoperative Care

http://www.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]

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