Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Miscellaneous issues• If fasting blood sugar is >7 mmol L -1 , treat the patient asdiabetic.• If OSA is diagnosed (snoring, daytime somnolence, apnoeawitnessed), GP should be asked to assess and refer to the sleepclinic according to agreed referral guidelines.• Arterial blood gas: indicated if S pO 2 is < 96% on air in sittingposition, or history of respiratory problems.• Patient should be advised to stop smoking.• Patients with cardio-respiratory disease, OSA having majorsurgery may need referral to a cardiologist or respiratoryphysician and HDU/ITU bed booked for post-operative period.These patients should be highlighted on the theatre list by PAACnurses.Premedication• Patient should continue with regular medication for cardiorespiratorydisease as for other patients.• Antacids: ranitidine or omeprazole.• Prokinetic drug: metoclopramide.• Non-opioid analgesics as pre-emptive analgesia.Intraoperative care• Sufficient theatre staff should be available to move and positionthe patient.• In some cases it may be safer to anaesthetise on the operatingtable in the theatre.• Appropriate size of gown, operating table and equipments e.g.BP cuff, tourniquet should be available.• Invasive (arterial) BP monitoring may be indicated, if noninvasivemonitoring is difficult.Anaesthetists Handbook January 2010 215