Continue perioeratively

D/c them increases the risk for morbidity and mortality 

D/C 6 hours prior to surgery

if not cardiac patient 

Hold the morning of surgery 

Try to scheduled diabetics for early morning surgery 

Recommend 2 days prior to reduce carboxyhgb, nicotine effects, mucous

Nicotine increase HR, BP, SVR- 1/2 life 4-60 minutes

CO- 1/2 130-190 mints

Need bronchodilators

Increased reactive airway disease

Increased URTI

Risk of laryngospasm, coughing, breath holding, desaturation 

Hold 24 hours prior

Risk of ischemia, CVA, arrythmias

Hold 7 days prior

Causes platelet inhibition--> risk of bleeding

Lowers BG--> hypoglycemia

Plt inhibition--> bleeding 

D/C seven days prior 

> 50 y/o

CMC: > 40 males, > 50 females 

Energy requirements and tolerability to eveyday exercise

If unable to met 4 then patient is at risk CV complications perioperatively and long term CV risk 

Keep HR below 100

Lead II- arrythmias

Lead V- Ischemia 

PaCO2 > 50 mmHg delay elective surgery

PaO2 < 60 mmHg: may indicate chronic bronchitis 

Bronchospasm

Laryngospasm

Hypoxemia

Atelectesis

Croup stridor 

Not seen until 70% of nephrons are damaged

Creatine clearance best measure

Need potassium 6-8 hrs of surgery for ESRD 

6-8 hours before

> 5.5 be concerned 

> 6 mEq you should cancel surgery 

CXR- 6 months

EKG- 30 days

Potassium- 7 days, ESRD 6-8 hrs

Glucose- that day

Pregnancy- if uncertain

Mendelson's Syndrome

25 ml of gastric acid can cause it

Use cricoid pressure, prokinetics, no LMAs if worried 

Severe or uncontrolled systemic disease with functional limitations

Renal failure, poorly controlled HTN, Cancer

Severe systemic disease that is a constant threat to life

Advanced COPD, CHF, Recent MI, Unstable Angina, Liver Failure

36 hours before surgery

Inhibits platelets 

5 days before surgery

Inhibition of NE reuptake