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Hypokalemia

Risk Defined as plasma K + <3.5 mEq Common conditions and/or treatments place pts at increased risk, including Those on diuretics (especially loop and thiazide diuretics) to treat Htn, CHF, and so forth. Those experiencing significant GI fluid loss (e.g., vomiting, diarrhea, or gastric suction). Those with increased serum pH (metabolic or respiratory alkalosis). Perioperative Risks Increased risk of cardiac dysrhythmias (with greater concern in those…

Hypertriglyceridemia

Risk Prolonged propofol infusion due to lipid vehicle Genetic defects in triglyceride metabolism Component of the metabolic syndrome (obesity, hypertriglyceridemia, low HDL, Htn, diabetes) Perioperative Risks Associated with atherosclerosis, coronary, and cerebrovascular disease. Hyperglycemia (metabolic syndrome) increases risk of surgical wound infection. Severe hypertriglyceridemia may cause acute pancreatitis. Worry About Coronary and cerebrovascular disease Pancreatitis Blood sugar control in metabolic syndrome Propofol infusion syndrome if hypertriglyceridemia…

Hyperthyroidism

Risk Incidence in USA: 300,000-500,000 individuals/y develop hyperthyroidism. In addition, 7.5% of pregnant women become hyperthyroid (highest prevalence in second trimester). 1:1000 females; 1:3000 males. Race with highest prevalence: Unknown. Perioperative Risks Risk related to occurrence of thyroid storm; increased risk of storm even if pt is made euthyroid prior to surgery. Some increased risk of resp insufficiency. Progressive increased risk of hypothyroidism after surgery on…

Hypertension, Uncontrolled With Cardiomyopathy

Risk 1.5 billion worldwide in 2014 70 million people in USA; approximately 1:3 people USA highest prevalence: African American Male = female Perioperative Risks Increased risk of MI and stroke Increased risk of CHF, ventricular hypertrophy, coronary artery disease, and atrial fibrillation Increased risk of cerebral hypoperfusion due to right shift of the cerebral blood flow autoregulation curve Increased risk of renal failure Increased blood loss…

Hypertension

Risk In USA about 77.9 million (1:3) adults have high BP. Incidence of Htn increases with advancing age. Half of people 60–69 y and three-quarters of people >70 y are affected. There is a continuous relationship between BP and the risk of CVD, including MI, heart failure, stroke, and kidney disease. For people 40–70 y, an increase of 20 mm Hg in systolic pressure or of…

Hyperparathyroidism

Risk Incidence in USA: 100,000 pts/y; increases with age Male:female ratio: 1:2; 0.8% in pregnancy Prevalence: 0.7% in general population; up to 3% in postmenopausal women Due to malignancy, vitamin D deficiency, sarcoidosis Perioperative Risks Hypovolemia and electrolyte disturbances Increased risk of cardiac dysrhythmias secondary to hypercalcemia Aspiration from full stomach and/or mental change Postop hypocalcemia Airway compromise due to hematoma or recurrent laryngeal nerve injury…

Hypernatremia

Risk Older age, infants, prior brain injury, DM, surgery, diuretic therapy, altered mental status, insufficient water intake, DI, hypertonic sodium solution (including sodium bicarbonate), hyperalimentation, hyperaldosteronism, Cushing syndrome, and hypothalamic injury Perioperative Risks Increased incidence of morbidity and mortality, seizures, coma, cerebral bleeding, and subarachnoid hemorrhage Worry About Increased risk of hospital death, residual and/or permanent neurologic disability If Na + corrected too rapidly, cerebral edema,…

Hypermagnesemia

Risk Pts with renal insufficiency, especially those receiving Mg 2+ -containing cathartics or antacids. Parturients on MgSO 4 therapy. “Runaway” infusion of Mg 2+ during transportation to the OR can cause acute, life-threatening hypermagnesemia. Risk of developing very high serum Mg 2+ levels in such cases can be reduced by always using a small-volume buretrol device in pts receiving IV Mg 2+ therapy. Therapeutic Uses Treatment…

Hyperkalemia

Risk Any pt with plasma K + concentration <5.5 mEq/L Perioperative Risks Muscle weakness and paralysis Cardiac conduction system abnormalities CV collapse: Peaked T waves (6–7 mEq/L) ST depression Prolonged P-R interval and widened QRS (10–12 mEq/L) Ventricular fibrillation or asystole Worry About Adverse effects are likely to accompany acute increases in K + ; chronic increases are better tolerated. Depolarizing muscle relaxants, especially if given…

Hyperglycemic Hyperosmolar State

Risk Elderly pts with DM, usually type II Debilitated pts who cannot care for themselves Chronically ill diabetic pts who experience exacerbation of an underlying comorbidity Incidence increased in African Americans, Hispanics, and Native Americans Perioperative Risks Severe hypovolemia and hemodynamic instability Presence of diffuse organ system damage from poor glycemic control Altered mental status and increased risk of pulmon aspiration Periop stress causing further elevations…

Hyperglycemia

Risk Incidence in USA: Can occur in virtually any anesthetized or critically ill pt Race with the highest prevalence: None Perioperative Risks Dehydration resulting from osmotic diuresis Increased likelihood of neurologic injury following brain ischemia and perhaps traumatic brain injury and spinal cord injury Increased infection rate Diminished wound healing Worry About Lyte abnormalities, particularly hypokalemia, while treating hyperglycemia. Hypoglycemia following insulin, resulting in insult to…

Hypercholesterolemia

Risk Incidence in USA: 71 million American adults have high LDL-C levels. Nearly 31 million adult Americans have a total cholesterol level >240 mg Risk factors for ASCVD include being a male age >45 y, being a woman age >55 y, family Hx of premature CAD, current cigarette smoking, DM, obesity, obstructive sleep apnea, Htn, CAD, high stress, high LDL-C, and low HDL-C. The LDL-C level…

Hypercalcemia

Perioperative Risks Pts with normal renal and CV function who have moderate hypercalcemia (11.5–13 mg/dL) have no special preop problems but may exhibit lethargy, anorexia, nausea, and polyuria. Lithium and thiazide diuretics should be held. Severe hypercalcemia (>13 mg/dL) carries risk for hypovolemia and acid-base abnormalities; therefore, normal intravascular volume and electrolyte status should be restored prior to surgery. Neuromuscular symptoms may occur with associated muscle…

Hyperaldosteronism, Secondary

Risk High renin states, and greater risks may be associated with the primary problem, leading to hyperreninemia. End organ damage from long-standing Htn (e.g., chronic kidney disease, cardiomyopathy). Abnormal glucose tolerance in up to 50% of pts with hyperaldosteronism. Perioperative Risks Risks include hypernatremia and hypervolemia with high total body sodium. Htn may be refractory to treatment, with increased risk of cardiovascular complications, including malignant hypertensive…

Hyperaldosteronism, Primary

Risk Responsible for up to 20% of moderate to severe systemic arterial Htn. End organ damage from long-standing Htn (e.g., chronic kidney disease, cardiomyopathy). Abnormal glucose tolerance in up to 50% of pts with hyperaldosteronism. Perioperative Risks Hypernatremia and hypervolemia with high total body sodium. Htn may be refractory to treatment, with increased risk of cardiovascular complications, including malignant hypertensive crisis. Hypokalemia and hypomagnesaemia with low…

Hydrocephalus

Risk Found in newborns and children with anatomic CNS abnormalities (including myelomeningocele) Head trauma and intracranial hemorrhage (prematurity, SAH, other causes) CNS tumors Meningitis Recurrent VP shunt malfunction Perioperative Risks Cerebral ischemia and neurologic sequelae Impaired airway reflexes,LOC, gastric emptying Cardiorespiratory arrest Worry About Intracranial Htn Persistent N/V Bradycardia Decreased LOC Overview Excess accumulation of CSF due to obstruction in normal CSF flow pattern from ventricular…

Huntington Disease

Risk General prevalence: 5-7:100,000 Highest prevalence in Caucasians of western European descent Perioperative Risks Increased risk of respiratory complications secondary to bulbar muscle incoordination Autonomic dysfunction Worry About Microaspiration, bronchospasm, chemical pneumonitis, and aspiration pneumonia Drug-drug interactions with anesthetic drugs and psychotropic medications Prolonged effects with succinylcholine Dysautonomia, gastroparesis, and fluctuating HR and BP Overview Inherited progressive neurodegenerative disease of the CNS, primarily the basal ganglia.…

Histiocytosis

Acknowledgment The authors would like to acknowledge the contribution of Drs. Jeremy Gibson and Meenakshi Dogra to this text in the previous edition. Risk LCH is the most commonly known form. Incidence: 1:250,000 in children, with about a third of this incidence in adults. Seen in all ages, but peak incidence is at 0–3 y of age. Male:female ratio: 1.5:1. Sporadic development with no established genetic…

Hirschsprung Disease

Risk Incidence of 1:5000 live births; varies among different ethnic groups. Male to female ratio is 4:1, although bias is lost in longer segment disease. Occurs as an isolated phenotype but may be associated with congenital abnormalities and associated syndromes. Up to 30% of affected individuals have at least one coexisting congenital anomaly, which may include congenital heart defects, gastrointestinal malformations, central nervous system, genitourinary, and…

Herpes, Type II

Risk Incidence within USA of HSV-2 is estimated at 40–60 million (20% of sexually active adults). Approximately 536 million people (16% of population) infected worldwide, most unaware of the disease. Highest prevalence in women, African Americans, and lower socioeconomic groups. Frequency and severity of infection increases in immunocompromised pts, including HSV encephalitis. Incidence of neonatal HSV infection is estimated at 1:2000-5000 deliveries. Perioperative Risks Vertical transmission…