Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Recovery and patient handoverMiscellaneous issuesPatients that you have left in a recovery area remain yourresponsibility until handed over to another clinician. At the Hospital ofSt Cross, you may not leave a patient in recovery and then leave thehospital without handing over your patient to another anaesthetist.Renal patients – clinical guideline[Appraised by Dr Andrew Phillips, January 2010]Anaesthesia for patients with renal dysfunctionDr Ravi Joshi and Dr Anne Scase devised this guideline in 2002. Therenal teams apply it on the renal wards (usually ward 50) and youmust be aware that staff will give care according to these principles.Patients suffering from chronic renal failure (CRF) and end stagerenal disease (ESRD) often tend to have multiple organ dysfunctions.Naturally they pose high risks for anaesthesia and surgery.IntroductionPatients with renal dysfunction may require anaesthesia forprocedures to improve and support existing renal function or othercoincidental surgery. The risks are increased if the patients present insuboptimal clinical condition. It is important to understand thepathophysiology that has a direct bearing on the safe and successfuloutcome following anaesthesia and surgery.At the University Hospital, surgical renal replacement therapy (RRT)is offered to appropriate patients with CRF and ESRD. This could be:• Insertion of CAPD.• Creation of vascular fistula.• Renal transplantation.Preoperative periodThe operation list is normally published on CRRS several days beforesurgery. The majority of the renal patients have detailed clinicalAnaesthetists Handbook January 2010 231