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Sleep Apnea, Obstructive

Risk Incidence in USA is 3–15% of the whole population (increased fourfold in last 15 y, presumably due to increase in obesity). M:F ratio: 2.5:1. Race with highest prevalence: Unknown. Perioperative Risks Increased risk of pulm Htn, RV failure, and systemic Htn. Some pts may be polycythemic and have an increased risk of CVA. Complications associated with obesity and craniofacial and upper airway soft tissue abnormality.…

Sleep Apnea, Central and Mixed

Risk Incidence USA is 3–12% of middle-aged adults (which has increased fourfold in last 15 y, presumably due to increase in obesity). The M:F ratio is 2–2.5:1; obstructive or mixed. Risk increases with male sex, upper middle age (55–64 y), obesity, and Hx of snoring with impaired daytime performance. In elderly, risk is 2× higher for African Americans. Perioperative Risks Increased risk of central and mixed…

Single (Including Common) Ventricle

Risk HLHS is the most common SV congenital cardiac malformation. HLHS accounts for 7.5% of newborns with CHD. Male predominance for HLHS. Perioperative Risks Paradoxical emboli. Complications of chronic hypoxemia: Hyperviscosity, decreased coagulation factors and platelets Surgical shunts (narrowing of vessels anastomosed, obstructed shunts) Hypovolemia-induced poor pulm blood flow or shunt occlusion. Additional risks specific to anatomy and planned procedure. Worry About Effect of changes in…

Silicosis

Risk Silicosis is irreversible fibronodular lung disease caused by inhalation of dust containing crystalline silica (alpha-quartz or silicon dioxide) during occupational exposure. Currently, >1,000,000 workers are exposed, with 200–300 deaths/y; protection devices decrease incidence. Mostly >65 y of age Incidence higher in males than females. No racial predilection. Perioperative Risks Hypoxemia, CO 2 retention with chronic respiratory acidosis, bronchospasm, pneumothorax, atelectasis, mycobacterium (30-fold increased risk for…

Sickle Cell Trait

Risk Incidence in USA: 3 million; 350 million in world Race with highest prevalence: African Americans Perioperative Risks Increased risk of complications following CABG. Periop mortality rate in published cases of SA trait is 0.8%. Some increased risk of CVA and pulm infection but not well quantified. Worry About Increased risk of vasoocclusive phenomenon with hypoxia and stress. Sudden death with stresses such as vigorous exercise…

Sickle Cell Disease

Risk Affects persons with African, Greek, Turkish, Italian, Arab, Latin American, and Indian ancestry. Incidence in USA: Most common disease identified through state-mandated screening, occurring in 1:2647 births; varies by race, occurring in 1:396 African-American births and 1:36,000 Hispanic births. Early mortality: Varies by type of disease. In one longitudinal study of pts with sickle cell anemia (i.e., Hgb SS homozygous), median age of death was…

Sick Sinus Syndrome

Risk Highest incidence occurs in pts >60 y. Common in pts who have had congenital heart defect repair surgery. Sinus node dysfunction is a common indication for pacemaker implantation. Perioperative Risks Syncope, symptomatic bradycardia, and asystole. Worry About Sinus bradycardia can be poorly responsive to atropine and require a pacer intraop. Termination of a tachy-brady event where an atrial tachycardia occurs can lead to a prolonged…

Shy-Drager Disease

Acknowledgment A sincere thanks to Drs. Brad J. Hymel and Don D. Doussan for their contribution to this chapter in the previous edition of this text. Risk More common in men than in women. Symptoms begin in fifth-seventh decades of life. Perioperative Risks Autonomic dysfunction with CV collapse due to decreased sympathetic outflow and abnormal parasympathetic homeostatic mechanisms Aspiration risk Worry About Orthostatic hypotension and intraop…

Sepsis, Severe Sepsis, and Septic Shock

Risk Incidence of sepsis within USA: Approximately 1 million per year and increasing. Severe sepsis and septic shock are associated with high morbidity and mortality, and septic shock is the most common cause of death among critically ill pts in noncoronary ICUs. Although in-hospital mortality rates are very high, they have been declining. With prompt and appropriate treatment, approximate mortality from septic shock is 20–30%. Increased…

Seizures, Tonic-Clonic (Grand Mal)

Risk Incidence in USA: 500,000–1,000,000 with recurrent tonic-clonic seizures. 10–20 million at risk to have one tonic-clonic seizure secondary to alcohol withdrawal, febrile convulsions (in children), CNS pathology, and/or metabolic disturbances. Prevalence of epilepsy is 0.5–1% of the population. Perioperative Risks Seizures: Periop seizures: Incidence is 3.1:10,000 pts; incidence related to LA toxicity is 120:10,000; in pts with known seizures undergoing RA, frequency is 5.8%. SE…

Seizures, Intractable

Risk Incidence in USA: 600,000 people with epilepsy have uncontrolled seizures. Racial predominance: None. Perioperative Risks Sudden death Status epilepticus Seizure-mediated cardiac dysrhythmias Worry About Liver toxicity from anticonvulsants (on the decline with the new drug generation) Periop trauma from convulsions Sudden death Status epilepticus postop Altered pharmacologic responses due to chronic drug therapy Overview Neurologic disease associated with birth, congenital malformation, trauma, CNS pathology, idiopathic.…

Seizures, Epileptic

Risk Incidence of epilepsy estimated to be 0.5–2.3%. 30–40% of pts with epilepsy will develop intractable seizures (>1/mo refractory to two or more medications). Approx 400,000 people in USA have medically uncontrolled epilepsy. Perioperative Risks Epilepsy has causality with a variety of syndromes throughout multiple systems. Various psychiatric disorders are assoc with epilepsy (e.g., migraines, depression, psychosis), and antiepileptic drugs are associated with mood, behavior, or…

Seizures, Absence (Petit Mal)

Risk Incidence of absence seizures in USA is 1.9–8 cases per 100,000 population. Seizures are most common in children aged 4–14 y but rare in adults. Perioperative Risks Risk of transition of absence seizures into tonic-clonic seizures or SE is low but still possible. Seizure induced sequelae, including physical injuries, tachycardia, hypertension, hypoxia, metabolic acidosis, pulm aspiration, elevated ICP, and cerebral edema. Worry About Seizure induction…

Scoliosis and Kyphosis

Risk Scoliosis is a lateral and rotational deformity of the spine that, when measured by x-ray, has a Cobb angle of >10 degrees. The incidence of this spine deformity is 1–4%. Most cases of scoliosis are idiopathic (70% of cases) with the infantile (<3 y) and juvenile (3–8 y) onset associated with higher morbidity and mortality than if developed later during adolescence (9–18 y). The F:M…

Scleroderma

Risk Incidence: 9:1,000,000 per y. Prevalence: 300,000 Americans have scleroderma. Male:female ratio is 1:4; highest in young African-American women. More severe in Native Americans and African Americans. 10-y survival is 55–60%; presence of pulm Htn is a major prognostic predictor. Perioperative Risks Severe hypotension secondary to hypovolemia Hypoxia secondary to pulm Htn and restrictive disease Failed intubation Worry About GI reflux Obliterative vasculopathy leading to pulm…

Scimitar Syndrome

Risk Occurs in 1 to 3–5:100.000 live births. The incidence could be higher because of asymptomatic cases in adult population. Perioperative Risks Significant risk of pulm Htn, respiratory failure, and cardiac failure in the periop period. Worry About Intraop pulm Htn crisis, severe bleeding with hypovolemia, worsening left to right shunt, and in critical cases, reverse shunt right to left with acute cardiac failure and cardiac…

Schizophrenia

Risk Most common psychotic disorder with a lifetime worldwide prevalence of 1% Increased risk of suicide (5–10%) Perioperative Risks Marked by deterioration of function and self-care Exacerbation of psychosis with abrupt discontinuation of medications Worry About Pt being uncooperative, combative, or catatonic. Increased morbidity and mortality due to poorly controlled coexisting systemic disease and increased incidence of alcohol and substance abuse. Drug interactions and side effects:…

Scheie Syndrome (Mucopolysaccharidosis Type IS)

Risk Incidence: 1:500,000 Inherited as autosomal recessive Perioperative Risks Difficult intubation Positioning difficulty Cardiac problems Worry About Macroglossia leading to difficult intubation Valvular heart disease, cardiomyopathy Stiff joints Spastic paresis Poor IV access Overview Described by American ophthalmologist Harold Glendon Scheie in 1962. Mildest form of mucopolysaccharidosis type (1) and a rare lysosomal storage disease. Pts are of normal height and do not show intellectual deficiency.…

Sarcoma

Risk Malignant bone tumors. Incidence is 1:100,000; 3000 new cases/y in USA, with bimodal age distribution (first peak during adolescence, second peak in older adulthood). Soft tissue sarcomas: Incidence is 1:100,000 for ages <20 y and 7:100,000 for ages ≥20 y; 12,000 new cases/y in USA; mean age at diagnosis is 58 y. Prevalence equal in both genders and all races except Ewing sarcoma (high Caucasian…

Sarcoidosis

Risk Risk varies; ≤1–80:100,000, with highest incidence in Sweden; in USA, occurs in 30 Presents in pts ages 20–40 y in USA. More common in African Americans than whites in USA. Females at greater risk than males. Perioperative Risks Severity depends on degree of airway, lung, cardiac, and CNS involvement. Worry About Airway granulomas distorting and obstructing anatomy risking obstruction with sedation and making intubation potentially…