• Lower limb amputation
    • Typical patient - high risk
      • Smoker
      • Diabetes
      • COPD
      • HT
      • CKD
      • Coronary artery disease
    • Pre-op
      • Resp
        • ABG & PFTs helpful
        • ET difficult to gauge
      • Optimisation
        • Statins may be beneficial
        • β-Blockers
          • Increased risk of CVA if started acutely
        • CVS
          • Rate control existing AF
          • Manage CCF, angina - liase with cardiologist
        • Resp
          • Nebs, steroids, antibiotics
        • Glucose
          • Consider VRIII, BG <10
        • Anaemia
          • Maintain Hb >8
        • Other factors
          • LMWH, clopidogrel, aspirin
          • Nutrition
          • Pre-op pain control
      • Baseline Ix
        • FBC
        • U&E
        • Coagulation
        • Glucose
        • 12 lead ECG
        • CXR
    • Perioperative
      • Timing
        • Ideally within 48hrs of decision, in daylight hours
        • Senior surgeon
        • Consultant input
      • Aims of anaesthesia
        • Cardiovascular stability
        • Normovolaemia, normothermia, avoid anaemia
        • Antibiotic prophylaxis
        • Consider invasive monitoring
      • Technique
        • Regional
          • May be beneficial
          • Not always appropriate
        • GA
          • SV or IPPV
        • Perioperative pain Mx
          • PCA, nerve blocks
          • Multimodal analgesia
        • Post-op
          • Avoid hypoxia, tachycardia, hypotension and anaemia
          • Consider HDU level care
          • Acute pain team follow up
          • Rehabilitation
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/early/2011/07/12/bjaceaccp.mkr024.full.pdf