Can you search for the latest guidelines we would need for this patient and cover all the complex comorbidities or edge cases we would need during surgery?
total knee arthroplasty perioperative management guidelines
perioperative glycemic control diabetes orthopedic surgery
obstructive sleep apnea perioperative risk management opioid
tranexamic acid total knee arthroplasty blood loss
PONV postoperative nausea vomiting prevention multimodal
chronic kidney disease perioperative drug dosing surgery
obese patient perioperative anesthesia obesity complication
preoperative anemia correction arthroplasty outcomes transfusion
VTE thromboprophylaxis total knee arthroplasty DOAC
adductor canal block spinal anesthesia total knee arthroplasty pain
diabetes mellitus HbA1c surgical infection wound healing arthroplasty
chronic kidney disease renal impairment perioperative NSAID ketorolac
ERAS enhanced recovery total knee arthroplasty protocol outcomes
intraoperative hyperglycemia surgical site infection arthroplasty periprosthetic joint infection
obesity total knee arthroplasty complications infection outcomes BMI
GLP-1 receptor agonist semaglutide gastroparesis aspiration anesthesia
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OSA management -- confirm CPAP arrives with the patient; plan spinal anaesthesia + opioid-sparing multimodal analgesia; continuous SpO2 monitoring post-op. This is the biggest acute safety risk.
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Glycaemic control -- her HbA1c of 7.9% is in the borderline zone. Confirm her oral agents (stop SGLT2i if prescribed, hold metformin day-of, hold any GLP-1RA if applicable). Target glucose <10 mmol/L intraoperatively with hourly monitoring. Plan for dexamethasone-induced glucose spike.
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Blood conservation -- pre-op IV iron if time allows (she is at Hb 11.4 with known iron deficiency history). TXA IV + topical at surgery. No crossmatch currently ordered -- re-evaluate if Hb drops further before June 11.
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PONV prevention -- she failed ondansetron before. Use a 3-4 agent protocol: dexamethasone at induction + palonosetron at end + aprepitant pre-op + scopolamine patch. Spinal anaesthesia reduces baseline PONV risk considerably.
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CKD drug avoidance -- no NSAIDs (no ketorolac, no ibuprofen, no diclofenac intraoperatively or post-operatively). Dose-reduce gabapentinoids. Monitor creatinine 24-48 hours post-op.