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Immunosuppression Perioperative Management — FRCA Final MCQ

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ModeratePreoperative AssessmentImmunosuppression Perioperative ManagementFRCA Final

A 45-year-old man (ASA II) with ulcerative colitis is on azathioprine 150 mg daily and prednisolone 20 mg daily. He requires an emergency subtotal colectomy. Regarding his immunosuppressive therapy, what is the anaesthetic implication?

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Correct answer: C — Azathioprine causes malignant hyperthermia susceptibility

Patients on chronic immunosuppressive therapy have: (1) increased perioperative infection risk (meticulous aseptic technique, consider prophylactic antibiotics), (2) potential adrenal suppression from chronic steroids (stress-dose hydrocortisone required: 25 mg IV at induction + 100 mg/24h for major surgery), (3) azathioprine should be CONTINUED perioperatively (stopping increases disease flare risk without reducing infection risk – BSR guidelines). Azathioprine may cause bone marrow suppression – check FBC pre-operatively. Immunosuppressed patients may have an attenuated inflammatory response, masking early signs of anastomotic leak or sepsis.

Reference: BSR – 2022 – Perioperative immunosuppression; CPOC – 2021 – Steroid supplementation