Perioperative Management

Respiratory Management

Smoking:

  • Cessation prior to OT if possible
    • At least 4 weeks
    • Ideally over 8 weeks
    • Abstaining 24/24 prior may still have benefit

OSA:

  • Screen with STOPBANG
  • Institution of CPAP pre-operatively if appropriate

Renal Management

  • Identify patients at risk for AKI and aim to mitigate these risk factors
    • Maintain volume state
    • Avoid nephrotoxins
    • Maintain adequate renal perfusion

Haematological Management

  • Identify patients with high bleeding risk
    • History
    • Platelet counts
    • Coagulation assays
  • Anaemia
    Defined as Hb < 120 g/L for women and < 130 g/L for men.
    • Iron deficiency anaemia should be treated with IV iron transfusion
    • EPO supplementation should be used pre-operatively when other causes of anaemia are excluded/treated
  • TXA should be used in anaemic patients
  • Cell salvage should be used for orthopaedic procedures with high anticipated blood loss

References

  1. De Hert, S., Staender, S., Fritsch, G., Hinkelbein, J., Afshari, A., Bettelli, G., … Wappler, F. (2018). Pre-operative evaluation of adults undergoing elective noncardiac surgery: Updated guideline from the European Society of Anaesthesiology. European Journal of Anaesthesiology (Vol. 35).