Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Myelomeningocele

Risk Incidence in USA: 1.7–10:10,000 live births. 70,000–100,000 individuals with myelomeningocele living in USA. Central Asian and Latin American countries have the highest incidence. Risk of myelomeningocele is 20 times higher in subsequent pregnancies. Reduced dietary folic acid, as well as antiepileptic medication exposure (valproic acid, carbamazepine), in early pregnancy also increases risk. Perioperative Risks Fetal surgery: Intraop fetal distress Preterm labor Risk of nonobstetric surgery…

Mycoplasma pneumoniae Infection

Risk Endemic/pandemic worldwide every 3–5 y. Outbreaks likely during summer and early fall. Affects persons of all ages. Long incubation periods of 1–3 wk. Transmitted person to person via aerosols. Frequent in closed and semiclosed communities. Common cause of upper and lower respiratory infections. Up to 40% of community-acquired pneumonias, “walking pneumonia.” Up to 5% of bronchiolitis in children. 3–10% of adults may develop bronchopneumonia. Clinical…

Myasthenia Gravis

Risk Prevalence of myasthenia gravis in USA is estimated at 14 to 20 per 100,000 population; there are approximately 36,000–60,000 cases in USA. Affects all races. Male:female ratio: 2:1. Perioperative Risks Postop NM ventilatory failure Postop pneumonia due to poor cough and secretion clearance Worry About Preop optimization of muscle strength Anticholinesterase medications, steroids, plasmapheresis Overview Characterized by weakness and fatigability of skeletal muscles. Inspiratory muscle…

Multisystem Organ Failure, Lung Dysfunction in

Risk 200,000 new cases of ARDS occur annually in USA. 0.2% of general surgical pts develop ARDS postop. Perioperative Risks Hypoxemia, hypercarbia, hemodynamic instability. ARDS hypoxemia requires ventilator management using high PEEP to achieve adequate oxygenation. High PEEP may impede right atrial/right ventricular preload. Lower RV preload can reduce stroke volume and cardiac output. This can lead to alveolar hypoperfusion, thus inhibiting carbon dioxide elimination and…

Multiple Sclerosis

Risk Affects more than a half million people in USA, with almost 10,000 new cases every year. Perioperative Risks Worsening of symptoms due to stress or infection Aspiration related to bulbar involvement Postop mechanical ventilation Worry About Hyperkalemia related to succinylcholine. Fever that could exacerbate the disease. Pt may come to surgery medically unoptimized. Overview A chronic progressive inflammatory T-cell–mediated demyelinating disease that affects the CNS,…

Multiple Organ Dysfunction Syndrome

Risk Most common cause of death for pts in ICU Incidence 11-40% of adult ICU pts Risk factors: (1) Severe illness at time of ICU admission; (2) severe sepsis or infection at time of ICU admission; (3) old age Associated with trauma, sepsis, shock, male sex, African American race, chronic health conditions, malnutrition, use of immunosuppressants Perioperative Risks Labile hemodynamics Difficulty with oxygenation and ventilation Malnutrition…

Multiple Myeloma

Risk Represents 1.6% of all new cancer cases in USA; estimated 26,850 new cases in 2015. Estimated 11,240 deaths, or 1.9% of all cancer deaths in USA in 2015. Incidence: 7.5:100,000 white males; 4.5:100,000 white females; 15.1:100,000 black males; 11.2:100,000 black females; 7.9:100,000 all races male; 5.1:100,000 all races female (based on 2008 to 2012 data). Race: 1.1% of all malignancies in white population; 2.1% of…

Multiple Endocrine Neoplasia Type 1 and 2

Risk Neoplastic syndromes inherited in an autosomal dominant pattern; variable penetrance and rare incidence. Syndromes involve more than one endocrine gland. MEN tumors and their effects may be underdiagnosed and unrecognized when pt presents for nonrelated surgery (MEN 2a and 2b associated with pheochromocytoma). Medullary carcinoma of thyroid (MEN 2a and 2b) is inherited, with almost 100% penetrance; prophylactic thyroidectomy is recommended. Genetic screening tests are…

Mucopolysaccharidoses

Risk All forms of MPS are autosomal recessive except MPS II (also known as Hunter syndrome), which is X-linked recessive (only males affected). Estimated incidence in USA: 1:30,000. Perioperative Risks MPS pts are at increased anesthetic risk (most complications are associated with airway obstruction), and surgery is associated with a high mortality rate. Worry About Airway obstruction, difficult airway management, cardiac pathology, obstructive and restrictive lung…

Moyamoya

Risk Occurs in both children and adults, peak age at 5 y and 40 y, respectively Female-to-male ratio of 1.8:1 Highest incidence in Japanese and Asian populations; familial occurrence 10% Perioperative Risks Stroke Worry About Hypocarbia and hypercarbia Adequate cerebral blood flow Hypotension Hypothermia Overview In Japanese, moyamoya means “puff of smoke,” which describes the angiographic appearance of collaterals between internal and external carotid arteries. Chronic…

Morbid Obesity

Risk Incidence in USA: Approximately 5% morbidly obese Perioperative Risks Increased morbidity and mortality versus normal BMI from resp and cardiac issues Worry About Challenging procedures: IV start, intubation, ventilation, epidural cath placement. Restrictive pattern of resp disease, hypoxemia, larger O 2 demand, small FRC; OSA is common, with associated cardiac issues. Htn: Systemic and pulm. DM. NASH. Reflux, hiatal hernia, and depression. Overview Defined by…

Mobitz II (Second-Degree Atrioventricular Block)

Risk Occurs after anterior infarction and can quickly proceed to third-degree heart block Perioperative Risks Risk of developing third-degree block Worry About Rapid development into third-degree block, which requires temporary transvenous pacing Overview Unlike Mobitz I block, Mobitz II block is located in bundle of His or bundle branches, resulting in lengthening QRS duration. PP and RR intervals are constant, and PR intervals are constant prior…

Mobitz I (Second-Degree Atrioventricular Block)

Risk Occurs after inferior MI or occasionally in trained athletes or in normal, sleeping people. Incidence varies based on etiology. Perioperative Risks Without associated heart disease and without symptoms, should not present undue risk during anesthesia (e.g., in trained athletes). If occurs secondary to inferior MI, periop risk depends on extent of ischemic area. Worry About Advancing to a higher-degree block if ischemic zone extends to…

Mitral Valve Prolapse

Risk Believed to be most common form of valvular heart disease, with an incidence of 2–3% in the general population. MVP is a progressive disease that begins in middle age and affects both men and women. Most common cause of chronic primary MR. Disease severity varies widely. Complications related to the disease are a consequence of arrhythmias, infective endocarditis, and progressive severity of MR with associated…

Mitral Stenosis

Risk Bimodal age distribution: 20–39 y and 50–60 y. Mitral stenosis is 2–3 times more common in women and is the most common valve disease affecting pregnant women. Most common among immigrants to USA from regions where rheumatic fever is prevalent (e.g., Middle East, Asia, Latin America). Perioperative Risks Increased risk of periop cardiac complications, including infectious endocarditis, pulm edema, resp failure, HF, tachyarrhythmias, new-onset AFIB…

Mitral Regurgitation

Risk Mitral regurgitation affects more than 2 million people in USA. Incidence of moderate/severe mitral regurgitation: Nearly 20% for age >55 y. Mitral valve prolapse is the primary form of myxomatous degeneration of the valve. Mitral valve prolapse is the most frequent diagnosed valve abnormality. Incidence in females is slightly higher than in males. Perioperative Risks Acute mitral regurgitation Atrial arrhythmias (tachycardia, atrial fibrillation, atrial flutter)…

Mitochondrial Myopathy

Risk More common than previously thought. Prevalence ranges from 1:7000–15,000. Occurrence is usually sporadic or maternally inherited. Perioperative Risks Metabolic acidosis Respiratory and cardiac insufficiency/failure Delayed emergence Worry About Respiratory failure following sedation. Consider aspiration risk. Metabolic acidosis. Hypotension during induction. Overview Clinically heterogeneous collection of diseases with myopathy of mitochondrial origin as common trait. Defects can be in electron transport, fatty acid, and amino acid…

Mitochondrial Disorders

Risk Incidence 4–7:100,000; might be under-reported Perioperative Risks CNS: Facial and bulbar weakness, mental retardation, seizures, learning disabilities, deafness, visual impairment, and stroke-like episodes CVS: Cardiomyopathy and cardiac conduction defects Respiratory: Weakness of muscles of respiration and respiratory failure Other: GI disturbances, diabetes mellitus, exocrine pancreatic insufficiency, lactic acidosis, liver failure, and renal tubular defects Overview Characterized by pathologic mitochondrial dysfunction in oxidative phosphorylation. Variable clinical…

Methemoglobinemia

Risk Incidence within USA: Rare Gender prevalence: None Socioeconomic or ethnic prevalence: None Perioperative Risks Inadequate O 2 carriage and delivery to tissues. Hemolysis may be induced by methylene blue, especially in pts with G6PD deficiency. Worry About Percent of MetHb. Symptoms vary and depend on the level of MetHb present: Cyanosis appears when MetHb reaches 10–20%. Tachycardia and tachypnea can appear when MetHb reaches 20–50%.…

Mesothelioma

Risk Incidence in USA: Approximately 2000–3000 new cases annually and decreasing. Increasing incidence in developing countries due to poor regulation of asbestos in mining and industrial use Attributable mortality: 14 deaths per million in USA Male to female ratio: 3–6:1 0.16% of all malignancies Perioperative Risks Usually discovered in geriatric male undergoing lung biopsy Pleural effusion General debilitation from malignancy Worry About Previous needle biopsy of…