78yo male with patella ORIF in 2020 after MVA. Hardware now painful, for removal.
- Significant respiratory disease
- FEV1 30%, FVC 70%
- Recent respiratory physician review – ‘as good as he gets’
- IHD – further details unclear. ECG normal
- Upper airway cancer – treated with radiotherapy.
- Bladder tumour – local radiotherapy, quiescent
- Post-traumatic epilepsy after fall from horse decades ago.
- Distant PE
- METS 3
- Iron deficiency anaemia
Issues and discussion
- Should surgery proceed
- Reasonable indication for surgery
- Uneventful surgical episode last year, reassuring
- Optimisation of lungs possible?
- ARISCAT score = low risk (0.9%) for postoperative pulmonary complications
- Given he has been reviewed by the respiratory physician recently, nil further optimisation felt possible.
- Anaesthetic technique?
- Patient amenable to spinal anaesthetic. Good option.
Plan and Requested Actions:
- Proceed to OT.
- Normal ward-based care assuming nil complications intraop.