Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Juvenile Gaucher Disease (Type III/Subacute Neuronopathic)

Risk Less than 1:100,000 Autosomal recessive with no sex predominance Panethnic but more common in Northern Sweden and Palestinian town of Jenin Perioperative Risks Abnormal platelet functioning and increased risk of bleeding Respiratory failure Seizure Worry About Intraoperative blood loss and need for transfusion of PRBC, FFP, and platelets Perioperative continuation of anticonvulsant therapy and possible need to supplement GERD and aspiration Potential presence of restrictive…

Jeune Syndrome (Asphyxiating Thoracic Dystrophy)

Risk Incidence in USA: 1:100,000-130,000 live births and prevalence of 2.6:100,000. No race or sex predilection. Skeletal survey by US after 14 wk gestation can detect defining deformities. Heterogeneous presentation, from mild to fatal. Perioperative Risks 70–80% mortality in infancy for severe cases Respiratory failure from small thoracic cage and hypoplastic lungs; frequent infection in those with ciliary dysmotility Progressive renal disease with cystic lesions and…

Jehovah’s Witness Patient

Risk More than 8 million members worldwide Headquarters in Brooklyn, New York; new world headquarters under construction in Warwick, New York Perioperative Risks Possible morbidity and/or mortality from massive hemorrhage secondary to religious dogma banning members from accepting blood transfusions. Appropriate blood conservation measures (i.e., autologous blood salvage, normovolemic hemodilution, reduction of intraoperative and iatrogenic blood loss) in pts who do not accept autologous blood transfusions…

Jaundice

Risk Chronic liver disease consistently the ninth most common cause of death in USA Male to female ratio: 2:1 African American to Caucasian ratio: 2:1 Perioperative Risks Jaundice per se poses no special risks; at least 25% present with severe pruritus. Risks are associated with coexisting or underlying conditions. Use of regional anesthesia limited by coagulopathy and ascites. Worry About Biliary obstruction Chronic liver disease: Hepatopulmonary…

Intraoperative Recall

Risk Incidence in USA: 20 million anesthetics annually Perioperative Risks Incidence is approximately 0.1% in general surgical population and increases to approximately 1% in high-risk populations. Procedure risk factors include OB surgery, cardiac surgery, trauma, and rigid bronchoscopy. Pt risk factors include prior awareness, significant CV disease, COPD, substance abuse, chronic opioid use, and chronic benzodiazepine use. Anesthetic risk factors include absent/low benzodiazepine premedication, absent/low halogenated…

Intracranial Hypertension

Acknowledgment Thank you to Kevin J. Gingrich for his contribution to the previous version of this chapter. Risk Incidence in USA: >50% of pts presenting with head trauma or other intracranial pathology (>600,000/y) Gender predominance: Only for certain etiologies (i.e., TBI and males) Perioperative Risks Increased risk of herniation leading to subsequent brain infarction, disability, coma, and death Worry About Controlling ICP and preventing brain ischemia/herniation…

Insulinoma

Risk Most common functional islet cell tumor of pancreas Incidence: 1–4 per million population per year Mean age of onset: 47 y Presentation earlier (mean age 25 y) if part of MEN-1 More common in females Perioperative Risks Hypoglycemia Worry About Preop and intraoperative hypoglycemia Post-excision rebound hyperglycemia (not always present and not reliable to validate completeness of resection) Possibility of multiple islet cell tumors or…

Infratentorial Tumors

Risk Highest incidence: Age 3–12 y and 55–65 y Two-thirds of childhood CNS tumors; approximately 3–5:100,000/y under age 19 y 15–20% of adult CNS tumors; incidence lower than in children Perioperative Risks Very confined space, brain tolerates tumor poorly, leading to symptoms and less forgiving with surgery than supratentorial CSF obstruction with hydrocephalus common; ICP tolerated poorly Worry About Increasing ICP and hydrocephalus Impaired protective airway…

Implantable Cardioverter-Defibrillators

Epidemiology In USA, more than 300,000 people have an ICD and more than 180,000 ICDs are implanted annually, based on CMS registry data. Given current implant and survival rates, nearly 700,000 people in USA may have an ICD by the year 2020. ICD implant is indicated for any-cause cardiomyopathy with EF ≤35% and without evidence of dysrhythmia; thus some pts undergo ICD implantation for “primary prevention.”…

Immune Suppression

Risk The incidence of HIV infection has been stable in USA, at approximately 20–30 newly diagnosed infections per 100,000 population per y. 20–25% of HIV infected pts will require surgery. Major risk factors: Neutropenia, yeast overgrowth, and/or nosocomial colonization of skin and mucosa. Perioperative Risks In one study of AIDS pts undergoing intraabdominal surgery, 22.2% 30-d mortality was reported. Mortality is greatest at the extremes of…

IgA Deficiency

Risk Most common immunodeficiency disorder. Incidence estimated to be 1:100 to 1:1000. More prevalent among European descendants. Most pts are clinically normal. Increased risk of allergies and anaphylaxis. Increased risk of malignancies. Perioperative Risks Increased incidence of pulm complications, atopic disorders, and postop infections Worry About Recurrent sinopulmonary infections leading to decreased pulm reserve Associated autoimmune disorders (e.g., lupus, DiGeorge syndrome) Associated GI disorders leading to…

Hypoxemia

Risk All pts undergoing anesthesia and surgery (7–35% in large series have Pa o 2 <60 mm Hg in OR or PACU). Pts with pulm disease, difficult airway management, severe hemodynamic instability. Perioperative Risks Hypoxemia may lead to hypoxia and eventual severe neurologic/cardiac sequelae or death. Worry About Inadequate delivery of O 2 to lungs and blood is the greatest concern to the anesthesiologist because it…

Hypothyroidism

Risk Hypothyroidism may be present in 2-5% of the general population and is more common in women and the elderly. Approximately 3% of adults receive chronic thyroid replacement. Perioperative Risks If inadequately treated, increased risk for hypothermia, hypotension, cardiac failure, and GI dysfunction. Periop mortality rate not increased unless overtly hypothyroid. Inadequate thyroid replacement associates with adverse obstetric outcomes and developmental delays in the offspring, but…

Hypothermia, Mild

Risk Greater in infants and children Greater in longer, larger operations Similar in RA and GA Perioperative Risks Surgical wound infections Coagulopathy Reduced drug metabolism Prolonged recovery and hospitalization Shivering and thermal discomfort Overview Benefits: Improved neurologic recovery in asphyxiated neonates Decreases triggering and severity of malignant hyperthermia. Core temperature normally protected by responses that include sweating, vasoconstriction, and shivering. Typical doses of GA have little…

Hypoplastic Left Heart Syndrome

Risk Frequency: 0.163–0.184 per 1000 live births 7–9% of all congenital heart diseases Approximately 1000 infants/y in USA Male to female: Up to 2:1 15% is associated with genetic syndromes, such as Turner syndrome, Jacobsen syndrome, trisomy 13, trisomy 18, and Smith-Lemli-Opitz syndrome Perioperative Risks 60% prenatally diagnosed (18–22 wk) 90% mortality within the first month without operation 70% overall survival to adulthood 30% mortality within…

Hypopituitarism

Risk Incidence: 45.5:100,000. 30% of pituitary macroadenomas (>10 mm) cause one or more hormone deficiencies. About 4.2 years after pituitary radiation therapy, some 50% of pts have hypopituitarism. Less common causes include empty sella syndrome, head trauma, infiltrative disease, and expansive internal carotid artery aneurysm. Perioperative Risks If hormone replacement is adequate, surgery presents no increased risk. If due to secreting tumor, there is an increased…

Hypophosphatemia

Risk Incidence: 1% of population, 5–20% of hospitalized pts Perioperative Risks Acute respiratory or cardiac failure, generalized weakness, confusion, seizures 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

Hypoparathyroidism

Risk Most common cause of both acute and chronic hypoparathyroidism is surgery of the neck, including thyroidectomy, parathyroidectomy, and radical neck dissection. Nonsurgical hypoparathyroidism is rare. Etiologies include autoimmune disease, infiltrative diseases (e.g., hemochromatosis, Wilson disease), hypomagnesemia or hypermagnesemia, and genetic disorders involving PTH biosynthesis or parathyroid development (e.g., DiGeorge syndrome). Perioperative Risks Severe hypocalcemia leading to heart failure, hypotension, arrhythmias, laryngospasm, bronchospasm, seizure, or altered…

Hyponatremia

Risk Preop hyponatremia is a prognostic marker for increased 30-d mortality, major cardiac events, wound infection, and pneumonia. Premenopausal women, especially those undergoing procedures associated with rapid irrigant absorption, are at particularly high risk of both symptomatic hyponatremia and osmotic demyelination with Na + correction. Conditions associated with SIADH or adrenocortical insufficiency (Addison disease). Elderly taking diuretics. Pts with liver, heart, or renal failure. Hyponatremia especially…

Hypomagnesemia

Acknowledgment The author would like to acknowledge Drs. Mehmet Ozcan and James Feld’s contributions to this chapter in the previous edition. Risk 12% of all hospitalized pts as well as 44–60% of all pts admitted to medical/surgical and pediatric ICUs, are hypomagnesemic. Associated with Poor nutrition. GI losses: Diarrhea and severe vomiting; malabsorption (steatorrhea, bowel resection, intestinal fistulas, celiac disease); acute pancreatitis; medications (proton pump inhibitors,…