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Thrombocytopenia

Risk Commonly present in pts with systemic illness (e.g., sepsis), pathologic conditions of pregnancy, and in pts requiring extracorporeal circulation. Prognosis is determined by underlying illness, not absolute platelet count. HIT, a prothrombotic immune-mediated disorder, occurs in <5% of pts exposed to heparin. Perioperative Risks Bleeding associated with invasive procedures. Worry About Spontaneous bleeding when platelet count <10,000/μL Bleeding from nonneurologic invasive procedures when platelet count…

Thalassemia

Risk Over 60,000 children are born annually with severe beta-thalassemia. Global regions that are primarily affected include the Mediterranean, North Africa, and Southeast Asia, where alpha thalassemia is more common. Beta-trait carrier status has a global prevalence of approximately 1.5%. Over 200,000 pts are currently receiving treatment for thalassemias. In endemic areas with highest frequency, carrier status is present in as many as 1:7 individuals, and…

Tetralogy of Fallot

Risk Occurs in 4-5:10,000 live births (1:2,000–2,500) Most common cyanotic CHD (10% of all CHDs) Occurs equally in males and females Perioperative Risks If unrepaired, tet spells can lead to RVH, RV failure, and death (50% in first year of life). Mortality after TOF repair: 5–8% in first 2 y postrepair (if uncomplicated anatomy). Increased mortality if coexisting PA hypoplasia, atresia, or major AP collaterals. Worry…

Tetanus

Risk A major public health problem in the developing world, but improving; responsible for 200,000–300,000 deaths/y in 2000 and only 60,000 in 2013, and the vast majority were neonatal deaths. Incidence in USA: 0.16 cases/million population (1998–2000). Highest incidence in USA is among the elderly (>60 y), persons of Hispanic ethnicity, older adults with diabetes, and parenteral drug users. Perioperative Risks Difficult airway or intubation in…

Takayasu Disease

Risk Worldwide incidence: 2.6 cases per million per y. Race with highest prevalence: Asian. Females 8–9 times more likely to be affected than males. Perioperative Risks Severe uncontrolled Htn leading to end-organ dysfunction Stenosis of major blood vessels affecting regional circulation Difficulties in monitoring BP. Long-term corticosteroids. Worry About Multiple occlusions of peripheral arteries, CHF, stroke, cardiac valve dysfunction, hypertensive episodes, intracranial hemorrhage, and iatrogenic adrenal…

Systemic Lupus Erythematosus

Risk Prevalence: 1:2500 in Northern Europeans and 1:500 in African American population. Female:male ratio: 9:1. Peak age of onset is between 16-40 y; 20% of SLE pts present prior to age 16 y. Perioperative Risks Increased lupus activity is associated with surgery and stress. Infections can initiate lupus or cause a relapse. Worry About CV: Htn, CAD, pericarditis, Libman-Sacks endocarditis with mitral insufficiency, myocarditis, pulmonary Pulm:…

Syndrome X

Risk True incidence unknown Postmenopausal or posthysterectomy women most often at risk Common cause of chest pain in women with angiographically normal coronary arteries Linked to adverse cardiovascular outcomes and a poor quality of life No diagnostic test Perioperative Risks Acute withdrawal of sex hormone replacement can potentially lead to symptoms. Preop angina can delay procedures. Worry About Discontinuation of medications (HRT) can precipitate symptoms You’re…

Syndrome of Inappropriate Antidiuretic Hormone Secretion

Risk Elderly pts Nursing home residents Planned major operations, especially neurosurgical procedures Pts receiving exogenous hormone therapy, especially desmopressin CNS disorders including psychiatric diseases Cancer, especially small-cell lung cancer Lung disease Perioperative Risks Hyponatremia Cerebral edema causing altered mentation, seizures, and coma Acute water intoxication and fluid overload Worry About Other causes of hyponatremia, such as heart failure, liver failure, renal failure, or pseudohyponatremia (e.g., hyperglycemia)…

Swallowing Disorders

Risk Neuromuscular disorder or mechanical obstruction can cause difficulty in swallowing (dysphagia). Dysphagia can be classified into distinct types: Oropharyngeal dysphagia due to malfunction of the tongue, pharynx, larynx and/or upper esophageal sphincter and esophageal dysphagia due to malfunction of the esophagus. Dysphagia is often a symptom of a systemic disease (impaired consciousness, sarcopenia, dyspnea). Effects of dysphagia can go undetected until more serious medical complications—such…

Supraventricular Tachycardia (Tachyarrhythmias)

Risk SVT is associated with advancing age and significant cardiac and pulm disease. PSVT is associated with WPW, congenital heart disease, and mitral valve prolapse. It is more common in younger pts. The mechanism is reentrant in nature. AAT may be automatic, triggered, or reentrant. It is seen more commonly in children and those with a Hx of prior atrial surgery. It is rare in adults,…

Supratentorial Brain Tumors

Risk Highest incidence age is 3–12 y and 55–65 y. Account for 80% of adult CNS tumors; incidence of primary tumor is ∼15–20:100,000 per y. Account for one-third of childhood CNS tumors. Perioperative Risks Increased ICP: Headache, seizures, neurologic deficit/dementia, visual and hearing changes, focal neurologic changes (hemiparesis, numbness, ataxia), and/or visual deficits if pituitary tumor present Endocrinopathy, fluid, and electrolyte imbalance Worry About AEDs: Dilantin,…

Substance Abuse Disorder (Perioperative)

Risk Incidence in USA (2013 estimation): 24.6 million (9.4% population) Marijuana 7.5%, heroin 0.27%, cocaine 0.6%, prescription drugs 2.5%, alcohol (heavy drinkers) 6.5%, tobacco products 25.2% Associations: Males, trauma, gunshot wounds, MVAs, falls, mental illness Perioperative Risks Difficult airway and IV access Hemodynamic instability, autonomic dysfunction Opioid tolerance, achieving adequate analgesia, hyperalgesia/pain intolerance Systemic/blood borne infections (HIV, hepatitis B and C, TB, septic arthritis) Malnutrition, coagulopathy…

Subphrenic Abscess

Risk Prior abdominal surgery, either open or laparoscopic Blunt or penetrating trauma GI perforation (malignancy, appendicitis, diverticulitis) Inflammatory bowel disease Immunocompromised pt Perioperative Risks Developing sepsis Worry About Respiratory compromise (pleural effusion, atelectasis, V/Q mismatching, ARDS) Preop ileus/bowel obstruction; aspiration risk Sepsis, including septic shock and associated renal failure and/or coagulopathy Increased capillary permeability (hypovolemia) High-output cardiac failure/LV dysfunction Lyte and acid-base disturbances Overview Classic findings…

Subclavian Steal Syndrome

Risk Uncommon entity with a variably reported clinical significance Male:female ratio: 2:1 Perioperative Risks Stroke from a plaque originating from vertebral artery system Stroke from a plaque originating from subclavian artery Worry About Worsening neurologic symptoms Upper limb ischemia Overview Retrograde blood flow from vertebral artery to distal subclavian secondary to proximal ipsilateral subclavian or innominate artery stenosis or occlusion occurs when the pressure at the…

Sturge-Weber Syndrome

Risk Incidence: 1 in 5000. Prevalence: No racial or sex prediction; sporadically occurring neurocutaneous syndrome. Perioperative Risks Increased risk of seizures, neurologic deficits, bleeding due to presence of angiomas involving the oral cavity, vascular abnormality, and congenital cardiac malformations. Worry About Seizures, mental retardation, neurologic deficits, headache Congenital glaucoma, retinal detachment Difficult airway Intracerebral angiomas Overview Described by Sturge (1879) and Weber (1929). Also known as…

Stevens-Johnson Syndrome

Risk Incidence of SJS and TEN, a more severe variant of SJS, is 2–7 cases per million per y. Incidence around 100 times higher in the HIV-positive population. More common in women. Affects all age groups. Perioperative Risks High risk for infection Hypovolemia Cutaneous, mucosal, and ocular injury Respiratory failure requiring mechanical ventilation in around 25% of pts Worry About Sepsis and septic shock Fluid and…

Spinal Muscular Atrophy

Risk Incidence: 7.8 -10:100,000 live births. Estimated panethnic disease frequency: ∼1:11,000. Perioperative Risks Airway: Intubation can be difficult. Pts may need postop respiratory support. Anesthetic risk varies significantly between the different types of SMA. Worry About Pts may display increased sensitivity and prolonged effect of neuromuscular blockers. Postop respiratory depression could be catastrophic. Concomitant pulmonary disease and bulbar dysfunction. Gastroesophageal reflux. Prolonged effects of nondepolarizing neuromuscular…

Spinal Cord Injury

Risk In USA, trauma is the number one cause. Approx 10,000–12,000 cases per y. Males (80%) primarily affected. Motor vehicle collisions, falls, violence (GSW), sports-related injuries, hematoma, and transverse myelitis most common. Perioperative Risks Hypotension, particularly in acute injury resulting in neurogenic shock and concurrent hypovolemia Autonomic instability, which may result in severe cardiopulmonary compromise. Worry About Autonomic dysreflexia (T6 or above, but as low as…

Spasmodic Torticollis

Risk Estimated prevalence of 9 cases per 100,000. ST, also known as cervical dystonia, is the most common form of focal dystonia. Peak incidence is in the fifth decade. Two times more common in females. 80% of cases are sporadic or primary. 20% of cases are secondary to an underlying brain lesion or trauma. Perioperative Risks Dysphagia Aspiration Consider comorbid neurologic problems such as seizures, cranial…

Smallpox

Risk Declared eradicated worldwide in 1980. Two repositories hold the variola virus: VECTOR in Koltsovo, Novosibirsk, Russia, and the CDC in Atlanta, Georgia, USA. Potential agent of bioterrorism. Vaccinations are not administered to the general public. In 2007, ACAM2000, the newest version of vaccine made of vaccinia virus, became part of the USA stockpile of smallpox vaccines. Perioperative Risks Hemodynamic compromise from dehydration and/or sepsis Worry…