Bilateral Total Knee Replacement in Obese Diabetic Patient

You are in pre-assessment clinic reviewing a 68-year-old female. She is booked for bilateral total knee joint replacement surgery. Her initial details and medications have been documented by the clinic nurse: Height 162 cm Weight 100 kg Body Mass Index 38.1 kg/m2 Medications: - insulin via pump - fentanyl patch 12 mcg/hr TD q72hrly - pregabalin 150 mg PO BD - paracetamol 667 mg PO TDS - quinapril/hydrochlorthiazide 10 mg/12.5 mg PO daily - atorvastatin 40 mg PO daily - aspirin 100 mg PO daily (stopped by surgeon 2 days ago) - clopidogrel 75 mg PO daily (stopped by surgeon 2 days ago) - pantoprazole 40 mg PO daily Allergies: penicillin (rash)