A 70-year-old man with cholelithiasis was scheduled for a cholecystectomy.

His blood pressure (BP)

was 230/120 mm Hg; pulse 60 beats/minute. Hematocrit was 38%; serum sodium, 140 mEq/L; and
serum potassium, 2.7 mEq/L. His medications included propranolol and hydrochlorothiazide

Preoperative Evaluation and Preparation

1. How would you evaluate this patient preoperatively?

2. Would you postpone the surgery? Why? What BP would you like the patient to
achieve before surgery?

3. Should all or any of the chronic medications be discontinued before the operation?

4. Should hypokalemia be treated before anesthesia? Why?

5. Should hypomagnesemia be treated before anesthesia? Why?

6. Does an asymptomatic carotid bruit increase the risk in these patients?

7. The surgery was postponed for 6 weeks. The patient has been on propranolol,
captopril, hydrochlorothiazide, and KCl. His BP was 160/95 mm Hg and potassium
4.0 mEq/L. How would you premedicate this patient?

8. If the patient is an untreated hypertensive patient with BP 170/100 mm Hg, would

you pretreat the patient preoperatively with an antihypertensive agent?