Hepatitis B

Hepatitis B,C, • Depends on the activity and the stage, with ↑ Post-op M&M • Risk of transmission to OR personal (use needle-less system) A→ RSI for GI bleeding, B→ hypoxemia due to shunt, restrictive lung disease, Pul HTN C→ hyperdynamic circulation, CHF D→ altered drug pharmacokinetics Heme→ anemia, ↓PLT, coagulation defect M→ ↓ albumin, lytes abnormality, hypoglycemia, acidosis Renal→ hepatorenal syndrome GI→ portal HTN, ascites, upper GI bleed CNS→ encephalopathy • Correct coagulation pre-op (FFP, Cryo, PLT, Vit K) • Consider paracentesis pre-op if respiratory compromise • Have an ICU consult and back-up bed • Lab: CBC-D, BUN, creat, lytes, coags(PT, PTT, fibrinogen), CXR, PFT, ECG, Echo, LFT, ABG

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Intra-op: Art-line, CVP/PAC, maintain temp, avoid overhydration → volume overload ↑ risk of citrate intoxication → need Ca Post-op: o delayed awaking → drugs effect, encephalopathy, metabolic (hypoglycemia) o Respiratory failure → keep intubated → ICU