Renal and Hepatic

Question 1

Causes

Clinical Signs: reduction plasma proteins, hypoglycaemia, reduction in clotting factors (no epidurals), reduced drug metabolism, thermoregulation issues

Concerns: hypothermia, peri-anaesthetic stress, prolonged recovery

Drug interactions: NO protein binding drugs, cardiovascular suppressing drugs, ACP (liver metabolism and long), Ketamine (post op increase liver enzymes, increases sympathetic nervous system, take away blood flow),

Answer 1

Hepatic disease

Question 2

Causes

Clinical Signs: Uraemia, electrolyte imbalances, hypoproteinaemia, dehydration, anaemia, metabolic acidosis, hypertension

Concerns: nausea (uraemia), pre-ox, renal function, cardiovascular function, post-op excretions, keep stress low, hypotension, positioning, U-cath,

Drug interactions: NO ketamine, alpha-2s and NSAIDS (excreted), + inotropes for BP, don’t stop Ca channel blocker/ ACE inhibitors, low dose opioids, low inhalant, multimodal analgesia

Answer 2

Renal disease