A patient presents for a radical nephrectomy for malignancy. He has a history of chronic obstructive pulmonary disease, ischaemic heart disease, a pacemaker and requires haemodialysis.
Full blood count, urea and electrolytes, chest X-ray, ECG, echocardiogram, pulmonary function tests.
What is the transfer factor? (discussion re: the pulmonary function tests)
How would you assess this patient's volaemic status?
Would you consider an epidural? Discuss the pros vs cons
How would you optimise this patient preoperatively?