Essence of Anesthesia Practice

Hyperglycemic Hyperosmolar State

Risk Elderly pts with DM, usually type II Debilitated pts who cannot care for themselves Chronically ill diabetic pts who experience exacerbation of an underlying comorbidity Incidence increased in African Americans, Hispanics, and Native Americans Perioperative Risks Severe hypovolemia and…

Hyperglycemia

Risk Incidence in USA: Can occur in virtually any anesthetized or critically ill pt Race with the highest prevalence: None Perioperative Risks Dehydration resulting from osmotic diuresis Increased likelihood of neurologic injury following brain ischemia and perhaps traumatic brain injury…

Hypercholesterolemia

Risk Incidence in USA: 71 million American adults have high LDL-C levels. Nearly 31 million adult Americans have a total cholesterol level >240 mg Risk factors for ASCVD include being a male age >45 y, being a woman age >55…

Hypercalcemia

Perioperative Risks Pts with normal renal and CV function who have moderate hypercalcemia (11.5–13 mg/dL) have no special preop problems but may exhibit lethargy, anorexia, nausea, and polyuria. Lithium and thiazide diuretics should be held. Severe hypercalcemia (>13 mg/dL) carries…

Hyperaldosteronism, Secondary

Risk High renin states, and greater risks may be associated with the primary problem, leading to hyperreninemia. End organ damage from long-standing Htn (e.g., chronic kidney disease, cardiomyopathy). Abnormal glucose tolerance in up to 50% of pts with hyperaldosteronism. Perioperative…

Hyperaldosteronism, Primary

Risk Responsible for up to 20% of moderate to severe systemic arterial Htn. End organ damage from long-standing Htn (e.g., chronic kidney disease, cardiomyopathy). Abnormal glucose tolerance in up to 50% of pts with hyperaldosteronism. Perioperative Risks Hypernatremia and hypervolemia…

Hydrocephalus

Risk Found in newborns and children with anatomic CNS abnormalities (including myelomeningocele) Head trauma and intracranial hemorrhage (prematurity, SAH, other causes) CNS tumors Meningitis Recurrent VP shunt malfunction Perioperative Risks Cerebral ischemia and neurologic sequelae Impaired airway reflexes,LOC, gastric emptying…

Huntington Disease

Risk General prevalence: 5-7:100,000 Highest prevalence in Caucasians of western European descent Perioperative Risks Increased risk of respiratory complications secondary to bulbar muscle incoordination Autonomic dysfunction Worry About Microaspiration, bronchospasm, chemical pneumonitis, and aspiration pneumonia Drug-drug interactions with anesthetic drugs…

Histiocytosis

Acknowledgment The authors would like to acknowledge the contribution of Drs. Jeremy Gibson and Meenakshi Dogra to this text in the previous edition. Risk LCH is the most commonly known form. Incidence: 1:250,000 in children, with about a third of…

Hirschsprung Disease

Risk Incidence of 1:5000 live births; varies among different ethnic groups. Male to female ratio is 4:1, although bias is lost in longer segment disease. Occurs as an isolated phenotype but may be associated with congenital abnormalities and associated syndromes.…