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Obese orthopaedics (Liaison, optimisation and planning (Orthopaedics -…
Obese orthopaedics
Liaison, optimisation and planning
Orthopaedics - timing of surgery, aim for Iron/Hb optimisation prior
Respiratory - sleep study, CPAP, commence pre-op
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Cardiology/haematology (if new anticoagulants used) - cessation plan for anticoagulation and ? bridging, post op anticoagulation plan and transitioning back to usual therapy
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Assessment
History
Comorbidities
Cardiac: HTN, IHD, Pulm HT, COr pulmonale, myocardial dysfunction, arrhythmias
Resp: OSA, Obesity, Hypoventilation syndrome
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Medications
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Antiplatelet or anticoagulants - ? regional technique, bleeding risk, indications
Immunosuppressants - steroid dependence, increased infection risk
Examination
Airway - No increased difficulty due to obesity, but may be due to OSA or comorbid Rheumatoid disease
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Investigations
Bloods FBE, iron studies, UEC, LFTs, BSL or HbA1c
ECG - ischaemia, arrhythmia, Right heart strain (OSA)
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Functional testing - CPEX, 6 minute walk test: Cardiopulmonary reserve - ?HDU
COnsider ECHO: ventricular function, valvular function, pulmonary pressures
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Anticoagulation plan
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DVT prophylaxis
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Optimal duration unknown: 10-35 days post op: TKR 10-14 days, THR 28-35 days