Essence of Anesthesia Practice

Diabetes Insipidus

Risk Hereditary/familial (rare): Nephrogenic DI due to mutations in the AVP receptor gene, with X-linked recessive transmission; or AQP2, usually with autosomal recessive transmission, but autosomal dominant transmission also occurs; overall, males at greater risk than females Central (hypothalamic) DI…

Diabetes, Type III (Gestational Diabetes Mellitus)

Risk Incidence of GDM approximately 5–6% of all pregnancies. Increased in African American, Hispanic, Asian, Native American, or Pacific Islander women. Risk factors: Maternal age >25 y. Previous delivery of macrosomic infant. Glucosuria. History of polycystic ovarian syndrome. Previous unexplained…

Diabetes, Type II (Noninsulin Dependent)

Risk Incidence in USA more than 25 million Highest prevalence: Hispanics and Native Americans Gender predominance: None Metabolic syndrome associated with obesity and sedentary lifestyle Perioperative Risks Increased risk 5–10 times if end-stage renal disease, CV, CHF, or autonomic neuropathy;…

Diabetes, Type I (Insulin-Dependent)

Risk Incidence in USA: 1.25 million. Perioperative Risks Risk of requiring a CABG is increased 5–10 times in presence of ESRD, CHF, or autonomic neuropathy; without these conditions, the risk is 1-1½ times that of a normal person. Worry About…

Dextrocardia

Risk Birth prevalence of approximately 1:10,000; equal sex distribution 25% have PCD, an autosomal recessive disorder Perioperative Risks Increased risk of cardiac decompensation, pulm Htn, resp failure, airway obstruction, sepsis, raised intracranial pressure, and death Increased likelihood of emergent open-heart…

Dermatomyositis

Risk Prevalence in USA: 3000–10,000. Group, demographics with highest prevalence include females, 2:1 relative to men, with a peak onset between 30–60 y of age. Perioperative Risks Increased risk of respiratory failure and infections postop Worry About Most case reports…

Depression, Unipolar

Acknowledgment I wish to thank Dr. Ian Yuan for his work on this chapter in the earlier edition of this book. Risk Affects 2–4% of population; equal occurrence by gender; highest in 25–44 y. Lifetime risk 10–25% for women and…

Delirium (Postanesthetic) and Dementia

Risk Risk factors for the development of POD can be categorized as pt or procedure related. Pt-related factors: Age >75 y. Preexisting cognitive dysfunction or depression. Male sex. Preexisting severe illness. Polypharmacy (>3 medications) and use of psychoactive medications. History…

Degenerative Disk Disease

Risk Risk factors determined by spinal level Cervical spine: C3 and C4 most common; 10% of degenerative disk disease Thoracic: uncommon; can be related to trauma or tumor; 0.2–1.8% of disk disease Lumbar; very common; 85–90% of disk disease; third…

Deep Vein Thrombosis

Risk Incidence in USA: 170,000–200,000 new cases; 90,000–100,000 recurrent cases. VTE is the third most frequent acute cardiovascular syndrome after MI and CVA. Half of all episodes are associated with recent surgery or hospitalization. VTE is recognized as the leading…