This is one of my older cases....so some of the details are muddy.

60 something lady admitted for AAA repair (around 5 cm) which will require supra renal cross clamp.

med history includes:

htn
oxygen treated COPD.....with nc o2 at 4 l/m...sats in low 90's
dm
diabetic renal insufficiency cr 1.5

Patient went to cath lab on hospital day one to evaluate anatomy.

Scheduled on hospital day 2 for surgery....cancelled because of inability to cross match blood because of antibodies.

Took several days to get blood available....and in between... patient went back to cath lab again for some reason known only to the vascular surgeon ( He's not the sharpest tool in the shed).

Finally gets scheduled for surgery around hospital day 6 or 7.

I see the patient....the significant lab is Cr is not 3+...for which a nephrologist was consulted....and who has some nice recommendations written in the chart....NAC...Bicarb infusion...avoid hypotension..avoid hypovolemia. maintain urine output..etc.....

So how about some discussion about this case.