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Patients with gastroesophageal reflux disease (GERD) are prone to regurgitation of acidic gastric contents, which could result in aspiration pneumonitis during the perioperative period. Aspiration of an acidic fluid worsens the severity of pneumonitis compared with a fluid with neutral pH. In patients with symptomatic reflux, consider premedication with an H2 blocker, a proton pump inhibitor, or a non-particulate antacid (e.g., 0.3M sodium citrate 30 mL) preoperatively to reduce gastric acidity (see Chapter 4).

Patients with hepatic disease often have issues with fluid and electrolyte imbalance, coagulopathies, and altered drug metabolism.³⁰ Perioperative complications, including jaundice, hypo-albuminemia, coagulopathy, and renal dysfunction, are increased in patients with advanced liver disease, ascites, esophageal varices, or acute liver failure. Preoperative workup may warrant investigations, including complete blood count (CBC), electrolytes, international normalized ratio (INR)/activated partial thromboplastin time (aPTT), renal and liver function testing, and correction of these abnormalities may be required.