Essence of Anesthesia Practice

Amyotrophic Lateral Sclerosis

Risk Estimated incidence of 1-3:100,000. Mean age of onset is in the 60s, but ALS can occur as early as the 20s. Disease duration is approximately 3 y from the time of diagnosis to death. While there is slight male…

Amyloidosis

Risk Incidence in USA: 1:100,000 Race with highest prevalence: Unknown Perioperative Risks Increased risk of periop renal failure, cardiomyopathy (arrhythmias and ventricular dysfunction), bleeding from coagulopathy Autonomic neuropathy Worry About Signs of CHF Dysrhythmias Decreasing urine output Overview Extracellular deposition…

Amniotic Fluid Embolism

Risk Risk factors include: advanced maternal age (>35 y); cesarean delivery; placenta previa; meconium; intrauterine fetal demise; placental abruption; meconium staining of the amniotic fluid; chorioamnionitis; and macrosomia. True incidence is unknown but estimated to occur in 2 to 8…

Alpha 1 -Antitrypsin Deficiency

Risk One of the most common inherited disorders (1 in 2500 in case of European ancestry; uncommon in Asians) Less than 10% of individuals with AAT deficiency are currently identified. AAT deficiency is the most common genetic cause of liver…

Allergy

Risk Incidence in USA: 5% of adults are allergic to one or more drugs. During surgery, the risk of anaphylaxis is ∼1:2500 to 1:20,000 depending on the agent, with a mortality rate of 4%. Females > males (1.6:1). Perioperative Risks…

Alcohol Abuse

Risk Incidence in USA: 10% of Americans, incl physicians, will abuse alcohol at some point in their lives. 1:5 surgical pts has some form of alcohol use disorder. Third leading cause of death and disability, incl 30% of traffic fatalities.…

Alagille Syndrome

Risk Also known as syndromic bile duct paucity Affects cardiac, musculoskeletal, ocular, facial, and neurodevelopmental systems Most common inherited disorder that causes chronic liver disease in children 1:100,000 births with equal gender incidence Perioperative Risks Cardiac congenital anomaly and hemodynamic…

Adrenal Insufficiency, Acute or Secondary

Risk Risk of adrenal insufficiency: 1/1000 to 1/10,000 (if steroids used in prior y). With steroids >20 mg/d (cortisol equivalent), >7 to 14 d within 1 y (large variability in pt response to dose, route(s), duration and timing of prior…

Addison Disease

Risk Prevalence 1:100,000 persons M:F ratio: 1:1.8 Perioperative Risks CV instability, labile BP, hypotension, shock Hypovolemia, hyperkalemia, cardiac dysrhythmia Limited response to vasopressors Worry About N/V and diarrhea leading to dehydration, electrolyte imbalances, and acid/base disorder. Acute adrenal insufficiency leading…

Acute Respiratory Distress Syndrome

Risk Recent data estimates the incidence at 190,000 cases per year in USA. True incidence is unknown due to difficulty in defining the disease and making the diagnosis. Represents 10.4% of all ICU admissions and 23.4% of pts requiring mechanical…