MK Pre-Anesthesia Consultation Note

PRE-ANESTHESIA CONSULT John Doe is a 65 y.o. year old male presenting to the PAT on 01 November 2024 in anticipation of their left knee arthroplasty on 15 November 2024. An AI scribe was used to dictate portions of this note. The patient was made aware of this prior to the start of the consult. They did not have any questions/concerns and they were agreeable to proceed. OHIP: 1234-567-890 SURGEON: Dr. Sarah Lee - Orthopaedic Surgery SITE: SHG ELOS: 2 days ALLERGIES: Penicillin - Rash Codeine - Nausea DIAGNOSIS/REASON FOR SURGERY: Osteoarthritis of Left Knee: Patient presents with severe degenerative joint disease of the left knee, refractory to conservative management including physical therapy and intra-articular injections. ANESTHETIC PROBLEM LIST: #Hypertension - Diagnosed 10 years ago, well-controlled on medication. - Currently managed with **Lisinopril** 10 mg PO daily. #Type 2 Diabetes Mellitus - Diagnosed 5 years ago, managed with oral hypoglycemics. - Current medications: **Metformin** 500 mg PO twice daily. - HbA1c 6.8% (01 October 2024). #Obstructive Sleep Apnoea - Diagnosed 3 years ago, uses CPAP nightly. - No recent sleep study, but reports good compliance with CPAP. #Chronic Opioid Use - Patient takes **Oxycodone** 10 mg PO three times daily for chronic knee pain. - Cumulative daily dose: 30 mg. - MME/day: 45 mg. #Echocardiogram Findings - Performed 05 September 2024. - Mild left ventricular hypertrophy with preserved ejection fraction (EF 55%). No regional wall motion abnormalities. FUNCTIONAL CAPACITY: Patient reports being able to walk two flights of stairs and walk four blocks before experiencing knee pain. He can perform light household chores without significant difficulty but struggles with prolonged standing or heavy lifting. ROS: Review of systems was otherwise grossly normal. The patient's anesthetic questionnaire was reviewed and no further issues were found beyond those identified above. Patient was asked if there were any outstanding issues with their health which they denied. SURGICAL HISTORY: - Cholecystectomy, 15 years ago - Appendectomy, remote Patient has had prior anesthesia without any issues. No family history of problems with anesthetics. No personal or family history of MH or pseudocholinesterase deficiency. MEDICATIONS: Lisinopril 10 mg PO daily Metformin 500 mg PO twice daily Oxycodone 10 mg PO three times daily (MME/day: 45 mg) ASA 81 mg PO daily SOCIAL HX: Patient is a retired accountant. He lives with his wife. He reports occasional alcohol consumption (1-2 drinks per week) and denies current smoking or recreational drug use. No language barriers. LABS: 01 October 2024: Hb 135, Hct 0.41, Plts 250, Na 138, K 4.1, Cr 85 MOST RECENT INVESTIGATIONS: #Echocardiogram: 05 September 2024, Mild left ventricular hypertrophy, preserved ejection fraction (EF 55%). #ECG: 01 October 2024, Sinus rhythm, left ventricular hypertrophy. PHYSICAL EXAM: Height 175 cm, Weight 90 kg, BMI 29 BP 130/80, HR 72, SpO2 98% on room air. Airway: Mallampati 2, good mouth opening, good neck extension, likely easy Dental: grossly normal Cardiovascular: S1S2, no murmurs, no gallops Respiratory: Clear to auscultation bilaterally, no wheezes or crackles Neurologic: grossly normal Other: grossly normal ASSESSMENT AND PLAN: In summary, John Doe is OPTIMIZED for left knee arthroplasty on 15 November 2024 with Dr. Sarah Lee - Orthopaedic Surgery. In the clinic today, the overall conduct of anesthesia was reviewed with John Doe. The CAS fasting guidelines were discussed. I've asked John Doe to continue all of their regular medications up until and including the day of surgery with the exception of: #ASA, hold for 7 days, last day 08 November 2024 #Oxycodone, continue as prescribed pre-op, consider dose reduction post-op We reviewed the following possible anesthetic types and associated risks. #General Anaesthesia (GA): Risks of sore throat, nausea and vomiting, dental damage, and remote chance of cardiovascular and respiratory complications. #Spinal Anaesthesia (Neuraxial): Risks of PDPH at 1%, infection at 1 in 1000, temporary nerve damage at 1 in 10000, permanent nerve damage at 1 in 250000, and failed spinal at 1 in 100. In terms of access, we spoke about the need for pre-op IV insertion as well as possible: #Arterial line I've also asked John Doe to bring the following on the day of surgery: #CPAP machine #All current medications in their original bottles I have ordered the following additional tests, pre-operatively. #CBC #Electrolytes and Creatinine As for pre-op I've gone through the liberty of ordering the patient: #Gabapentin 300mg PO night before surgery #Celecoxib 200mg PO morning of surgery John Doe's questions were solicited and answered. John Doe was made aware that the anesthesiologist on the day of surgery will make the final decision as to the anesthetic plan. The patient was agreeable to proceed.