HRAC Template

Dear Dr. Emily Carter, Thank you for referring John Smith, whom I reviewed in the high-risk anaesthetic clinic along with his wife, Sarah. He is being considered for a hip replacement. Mr. Smith has: - Hypertension, Type 2 Diabetes, and a history of a previous myocardial infarction. Previous surgeries include a coronary artery bypass graft (CABG) 5 years ago. Current medications and supplements: - Aspirin 75mg daily, Metoprolol 50mg twice daily, Lisinopril 10mg daily, and Insulin. No known allergies. They live with his wife in a bungalow. He is fully independent, can climb stairs with some difficulty, and leaves the house daily for short walks. He can walk for about 10 minutes before experiencing mild chest pain. Upon evaluation, the following findings were noted: - Blood pressure 140/85 mmHg, ECG shows sinus rhythm with old inferior infarct changes. ECHO shows mild left ventricular hypertrophy. Their airway assessment showed: Mallampati: Class II Mouth opening: Adequate Neck movement: Full Dentition: Good We had a thorough discussion about the intended benefits of surgery, the risks, and the potential implications balanced against the option of doing nothing and continuing as they are. In particular, we discussed the risks of general anaesthesia, including the risk of aspiration, cardiac arrest, and stroke. We also discussed the general risks associated with any operation, including complications such as a heart attack, stroke, chest or kidney infection, and ultimately death. We talked about how a perioperative complication may delay recovery and reduce the chances of returning to an independent existence. We noted that the only way to entirely avoid these risks is to forgo the surgery, but this would, of course, mean they would not benefit at all. Should you wish to proceed, please ensure that they have the standard pre-operative assessment. They will need to withhold Insulin prior to surgery. Yours sincerely, Dr. Irfan Raza Consultant Anaesthetist