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Antianxiety Medications

Uses Preop anxiolysis, anterograde amnesia, IV sedation, IV induction of anesthesia, suppression of seizure activity, muscle relaxation Perioperative Risks Sedation Respiratory depression Apnea Airway obstruction Delayed emergence Delirium Worry About Potentiation of respiratory depression with opioids You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Angiotensin II Receptor Blocking Drugs

Uses AT1–receptor antagonists, or sartans, are a group of pharmaceuticals that modulate the renin-angiotensin-aldosterone system. Their main use is in hypertension, diabetic nephropathy, and CHF. Perioperative Risks ARBs do not inhibit ACE; they do not cause an increase in bradykinin, which contributes to the vasodilation produced by ACE inhibitors and also some of the side effects of ACE inhibitors (cough and angioedema). Dementia: It has been…

Amphetamines

Acknowledgment The authors would like to acknowledge the contributions of Drs. Edgar J. Pierre and Faisal Huda to this chapter in the previous edition. Uses Attention deficit hyperactivity disorder Weight loss Narcolepsy Recreational Perioperative Risks Possible increased requirement for volatile anesthetic with acute use Possible decreased requirement for volatile anesthetic with chronic use (CNS depression) Catecholamine depletion with chronic use Increases in temperature with acute intoxication…

Alpha 2 Adrenergic Agonists

Acknowledgment The authors would like to thank Dr. Marco Caruso for his work on this chapter in the previous edition. Uses (Off-Label Uses Included) Treatment of hypertensive states (clonidine, guanfacine, guanabenz, alpha methyldopa). Sedation of mechanically ventilated pts (dexmedetomidine). Adjunct agent in general anesthesia (dexmedetomidine, clonidine, tizanidine). Sedation for awake intubation and other minor procedures (dexmedetomidine). Management of alcohol, nicotine, benzodiazepine, and cocaine withdrawal symptoms via…

Alpha 1 Antagonists

Uses First-line drug treatment for male lower urinary tract symptoms Treatment of primary hypertension (not as first-line therapy) Preop treatment of pheochromocytoma Emerging role in treatment of autonomic dysreflexia Occasionally used in treatment of Raynaud phenomenon Less commonly used in congenital heart surgery to reduce SVR and correct systemic-to-pulmonary blood flow ratio Less commonly used to achieve controlled hypotension intraop Being explored as a potential treatment…

Alkylating Agents

Uses Bone marrow transplants Breast and bladder cancers Lymphomas and leukemias Cancers of the lung, pancreas, and brain Ovarian and testicular cancers Multiple myeloma Sarcomas and melanomas Perioperative Risks Increased risk of infection Aspiration (subsequent to N/V) Prolonged succinylcholine action (CTX, thiotepa) Fluid retention (HN 2 ) Prolonged bleeding (thrombocytopenia) You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles…

Acetaminophen

Uses Minor analgesic for acute and chronic pain. First-line agent in WHO analgesia treatment ladder. First-line agent in treatment of pain in pregnancy and compatible with breastfeeding. Commonly administered in combination with codeine phosphate (e.g., paracetamol 500-mg and codeine 8-mg or paracetamol 500-mg and codeine 30-mg tablets). Commonly used as multimodal analgesic with an opioid-sparing effect. Risk Well tolerated in normal therapeutic doses. Overdose associated with…

ACE Inhibitors

Uses Treatment of essential Htn, CHF, and mitral regurgitation. Numerous studies show that ACE-I use improves symptoms and quality of life, as well as reduces mortality rate in elderly with heart failure and decreased LVEF. Decreases mortality after myocardial infarction. Safe and effective treatment of Htn in diabetics; strong evidence that ACE-I delays the progression of diabetic renal disease. Perioperative Risks Severe and prolonged hypotension in…

Wolff-Parkinson-White Syndrome

Risk WPW pattern (asymptomatic) prevalence: 0.15–0.25% in the general population and 0.55% in pts with a primary relative with WPW; autosomal dominant trait. WPW syndrome (ECG pattern and arrhythmia) prevalence is 0.005% to 0.07% in the general population and approximately 2% out of pts with WPW. It is often first presented in ages 20–40 y. Overview Definition: WPW syndrome is a preexcitation syndrome. Ventricular depolarization occurs…

Wilson Disease

Risk Incidence: 1:30,000. Slightly more common among Eastern European Jewish populations. Children and young adults tend to present with nonspecific GI symptoms. Adults tend to present with neurologic symptoms. Perioperative Risks Increased risk of liver failure, kidney failure, and cardiac complications. 6–12% of all pts require liver transplantation. Overview Presentation can vary widely. Hepatic symptoms tend to present prior to neurologic symptoms. Often nonspecific symptoms such…

Wilms Tumor

Risk Most common malignant renal tumor in childhood. Accounts for 6% of all childhood malignancies. 5-7.8 cases per million children <15 y old in the USA. Prevalence: Males equal to females. Peak age is 1–3 y. 5% bilateral. Relapse-free survival rate at 2 y: 90%. Pts with favorable staging have an 80–90% chance of cure. Pts with metastasis have 50% long-term survival. Overexpression of HER-2 oncoprotein…

Wegener Granulomatosis (Granulomatosis With Polyangiitis)

Risk Prevalence of 3:100,000 persons affected More common in the white race; however, no gender affinity Respiratory failure Upper airway compromise Cardiovascular instability Acute renal failure Peripheral neuropathy Bleeding disorder Perioperative Risks Medication toxicity, side effects, and interactions Systemic involvement, primarily respiratory, cardiovascular, and renal systems Airway compromise Overview Systemic vasculitis of small, medium, and occasionally large arteries Characterized by necrotizing granulomatosis of upper and lower…

Waldenström Macroglobulinemia

Risk Rare hematologic neoplasm (accounts for 1–2% of hematologic malignancies). In USA, age-adjusted incidence of 5.7 per million among males and 2.7 per million among females. Median age at diagnosis is 73 y. Racial preponderance: Whites >African Americans (4.1 vs. 1.8 million). 10-y survival rate is 66%. Factors associated with worse prognosis: age >65 y, hemoglobin <11.5 g/dL, platelet count <100,000, B 2 -microglobulin >3 mg/L,…

Von Willebrand Disease

Risk Most common inherited bleeding disorder. >1 million people within USA; 1% carry the gene (severe disease 1:10,000-1,000,000). No race/gender with highest prevalence. Perioperative Risks Significant risk of bleeding if untreated Increased risk if hepatic dysfunction present Worry About Excessive periop hemorrhage Concurrent antiplatelet agents or NSAIDs contributing to bleeding Adverse reactions to desmopressin therapy (seizures due to hyponatremia, hypotension, anaphylaxis) Overview Coagulopathy is characterized by…

Von Hippel-Lindau Disease

Risk Rare; approximate incidence is 1:36,000. Usually occurs in young adults with complex multiple manifestations. Perioperative Risks Pts with cerebral hemangioblastoma have a 23% incidence of VHLD; assess other systems carefully. Worry About Space-occupying central nervous tumors (retinal and cerebellar hemangioblastomas in 60% of pts). Pheochromocytoma (7–20% pts) may be undiagnosed. Pregnancy and childbirth may dramatically change disease progression and symptom expression; multidisciplinary involvement essential. Overview…

Vitamin K Deficiency

Risk Vitamin K deficiency bleeding (VKDB) from abnormal factors II, VII, IX, and X. Controversy exists regarding whether vitamin K deficiency leads to osteoporosis, abnormal cartilage calcification, and possible arterial calcification resulting in CV disease. Perioperative Risks Minor or massive hemorrhage unrecognized as VKDB Long-bone fractures during positioning the anesthetized pt (particularly in women) Worry About Underlying risk factors demonstrating unexplained coagulopathy. Intracranial hemorrhage in infants…

Vitamin D Deficiency

Risk High prevalence of deficiency (much more than previously recognized). At risk: Dietary insufficiency, breastfed infants, inadequate sun exposure, elderly, nursing home residents, institutionalized, dark skinned individuals, obese, post gastric bypass, IBD. Genetically predisposed: Rickets, osteomalacia. Worry About Hypocalcemia; vitamin D promotes calcium absorption in the gut and aids in maintenance of calcium and phosphorus levels. Without vitamin D, only 10–15% of dietary calcium and approx…

Vitamin B 12 /Folate Deficiency

Risk 5–10% of adults over the age of 65 have vitamin B 12 or folate deficiency. Vitamin B 12 (cobalamin) deficiency is associated with a strict vegan diet, pernicious anemia, gastrectomy procedures, exposure to nitrous oxide, HIV infection, H. pylori infection, certain medications, and ileal resections. Folate deficiency is associated with chronic alcoholism and malnutrition. Perioperative Risks Intraop: Increased risk of vitamin B 12 deficiency after…

Ventricular Tachycardia

Risk Structural heart disease (most commonly a chronic phase of MI); predictor of sudden cardiac death after MI. Most common cause of mortality with CHF. Cardiomyopathies, both hypertrophic and dilated, are assoc with VTach. Seen in genetic syndromes such as long QT syndrome, Brugada syndrome, and arrhythmogenic right ventricular dysplasia. Perioperative Risks Endogenous or exogenous catecholamines trigger VTach in susceptible pts. Central venous, pulm artery cath…

Ventricular Tachyarrhythmias

Risk VTach/VFIB are uncommon but potentially fatal dysrhythmias requiring urgent diagnosis and management. Risk increases with age owing to the higher incidence of structural and ischemic heart disease and cardiac failure. Primary cause of sudden death and accounts for 75–80% of sudden cardiac death. Incidence in USA is about 300,000/y and similar in other developed nations. Males at greater risk (46% vs. 34%). Pts under 30…