Recommendations of Denner and Townley for Managing a Patient with Anorexia Nervosa in the Perioperative Period

Concern

Management

dehydration

rehydrate prior to surgery

electrolyte imbalances

correct electrolytes prior to surgery

increased neuromuscular blockade with non-depolarizing agents and hypocalcemia or hypokalemia

neuromuscular monitoring

increased risk of aspiration

protect the airway; placement of nasogastric tube with gastric dilatation; extubate only when awake with intact laryngeal reflexes

dosing drugs by body weight

adjust dose to take into account abnormally low body weight

dosing drugs with significant binding to albumin with hypoalbuminemia

adjust dose to take into account reduced drug bound to albumin

tendency to hypothermia

monitor body temperature and maintain normothermia

decreased soft tissue with increased risk of nerve compression injury

position the patient carefully to avoid nerve compression

increased risk for cardiac arrhythmias during reversal of neuromuscular blockade

monitor ECG