A 50 year old diabetic and hypertensive patient on amlodipine and glimepiride is posted for elective AV fistula creation for dialysis in view of acute kidney failure. What is your view as anaesthesiologist with regard to pre-operative orders
**Core Concept**
The anaesthesiologist must carefully manage the patient's antihypertensive and diabetic medications to minimize perioperative cardiovascular and renal risks, particularly in a patient with acute kidney failure.
**Why the Correct Answer is Right**
The patient's antihypertensive medication, amlodipine, is a calcium channel blocker that may cause vasodilation and hypotension, which can be problematic during surgery. The diabetic medication, glimepiride, is a sulfonylurea that stimulates insulin release and may cause hypoglycemia, especially when combined with other medications or fasting. In a patient with acute kidney failure, the kidneys' ability to regulate electrolytes and fluid balance is impaired, making it essential to carefully manage fluid and electrolyte status. The anaesthesiologist must consider withholding or adjusting these medications to ensure the patient's safety during surgery.
**Why Each Wrong Option is Incorrect**
**Option A:** Withholding both medications abruptly may lead to uncontrolled hypertension and hyperglycemia, exacerbating the patient's condition.
**Option B:** Discontinuing amlodipine may cause rebound hypertension, while continuing glimepiride may increase the risk of hypoglycemia.
**Option C:** Continuing both medications as usual may lead to hypotension and hypoglycemia, increasing the risk of perioperative complications.
**Clinical Pearl / High-Yield Fact**
In patients with renal failure, it's essential to consider the half-life of medications and adjust dosages accordingly to prevent accumulation and toxicity.
**Correct Answer: B. Continue amlodipine but withhold glimepiride the night before surgery and reinitiate it post-operatively with close glucose monitoring.**