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Herpes, Type I

Risk 500,000 new cases of HSV-1 each year in USA (prevalence approximately 68%); 58% of people worldwide are seropositive. Symptoms are typically minor (malaise, myalgias, and painful vesicular oral lesions) or absent, except in immunocompromised pts. Perioperative Risks Theoretical risk that spinal anesthesia can spread HSV-1 infection to new dermatomes. Association of intrathecal morphine and reactivation of HSV-1 infections in obstetric population. Worry About Transmission of…

Herniated Nucleus Pulposus

Risk Incidence of symptomatic disc herniation is 1–2% in the general population. Most common age of presentation is during third and fourth decades of life. Smoking leads to reduced O 2 tension secondary to vasoconstriction, significant inhibition of cell proliferation and extracellular matrix synthesis, and increased abnormal type I collagen versus type II collagen overall, leading to disc degeneration. Chronic stress (e.g., chronic coughing, sitting without…

Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu Disease)

Risk Effects vary in racial and ethnic groups, with a wide geographic distribution. Men and women affected equally. In Vermont, frequency is 1:16,500. In Europe and Japan, frequency is 1:5000–8000. Perioperative Risks Excessive bleeding Paradoxical air, bland, or septic embolism to brain Worry About Chronic anemia due to hemorrhage, especially recurrent epistaxis. Due to danger of intrapartum or postpartum pulm hemorrhage, a pregnant woman with HHT…

Hepatopulmonary Syndrome

Risk Occurs in up to 10–32% of pts with cirrhosis. Dyspnea is present in up to 70% of cirrhotic pts for varying reasons (ascites, ILD, volume overload, anemia). Perioperative Risks Hypoxemia, often worsened on induction and post LT Aspiration Hemodynamic instability and CV collapse Acute/chronic renal insufficiency Myocardial infarction Worry About Full stomach and aspiration risk in presence of ascites and increased intraabdominal pressures Hypoxemia (exacerbated…

Hepatitis, Viral

Risk Viral hepatitis accounts for more than 50% of cases of acute hepatitis in USA. Caused by infection with any of at least five distinct viruses: HAV, HBV, HCV, HDV, and HEV. Most commonly caused by HAV, HBV, or HCV. With more widespread use of the HAV and HBV vaccine, the rate of infection has decreased. Hepatitis is a very common infection in economically developing countries…

Hepatitis, Halothane

Risk Multiple exposures to halothane is the most important risk factor. Prior Hx of jaundice or fever after anesthesia. Females more susceptible. Obesity an important factor. Age: Halothane hepatitis is rare in pts <10 y old (3% of all cases). Pts <30 y of age make up about 10% of all cases. Most cases occur in pts >40 y. In older pts, the disease is more…

Hepatitis, Alcoholic

Risk In USA, 8.5% of adults met DSM-IV criteria for current alcohol use disorder; 30.3% of adults met DSM-IV criteria for lifetime alcohol use disorder. Approximately 10–15% of alcoholics will develop alcoholic hepatitis and cirrhosis. Perioperative Risks Mortality rate of 60–100% of pts undergoing surgery during acute alcoholic hepatitis. Poorer prognosis when accompanied by increased bilirubin, increased Cr, PT >1.5× control, ascites, or encephalopathy. >10% of…

Hepatic Encephalopathy

Risk Incidence in pts with hepatic cirrhosis (about 0.1% of the population) is 50–70%. It is frequently subclinical, but can be exacerbated in the postop period by the surgical stress response, dehydration, and postop infection. HE is acutely worsened, in about 20% of pts, following surgical portacaval shunts, minimally invasive TIPS, and hepatic resections. Perioperative Risks Precipitation of encephalopathy from benzodiazepines, surgical procedure (portacaval shunt), postop…

Henoch-Schönlein Purpura

Risk Most common childhood systemic vasculitis; rare in adults. Reported annual incidence varies between 10-30 cases per 100,000 in children younger than 17 y and 3.4–14.3 cases per million in adults. Mean age of presentation is 6 y; mainly affects children between 4-11 y of age in up to 90% of cases. Occurs most commonly in spring; associated with recent URTIs in 90% of cases. Cases…

Hemosiderosis, Pulmonary

Risk Classically affects infants and children (80% manifest before 10 y old), but can affect any age group. No predilection for males or females. Worry About Restrictive lung disease Pulm Htn Cor pulmonale Alveolar hemorrhage Increased need for transfusion secondary to acute and chronic anemia Adrenal insufficiency secondary to chronic steroid use Overview Rare disorder of unknown etiology characterized by repeated episodes of intraalveolar hemorrhage and…

Hemophilia

Risk Incidence of hemophilia A, factor VIII (FVIII) deficiency is 1:5000 male births; for hemophilia B, factor IX (FIX, Christmas disease) deficiency, it is 1:25,000 male births. Number of people affected with hemophilia in USA is estimated at approximately 20,000. Von Willebrand disease is the most common hereditary bleeding disorder, with a prevalence of about 1%. Hemophilia A, FVIII deficiency, affects 80–85% of hemophiliacs; the remainder…

Hemochromatosis

Risk Incidence of primary (hereditary) hemochromatosis: In some Caucasian populations, 10% are heterozygous carriers and 0.25–1% homozygous. Age: Clinical manifestations typically occur after age 40 in men and later in women due to the protective effect of menses. Perioperative Risks Infection due to accumulation of iron in immune cells Glycemic disturbances Bleeding risk from low levels of clotting factors or platelet dysfunction Decompensated heart failure and/or…

HELLP Syndrome

Risk Occurs in 0.1–0.9% of all pregnancies. Previous history of preeclampsia or HELLP syndrome is a risk factor for HELLP. Occurs in 10–20% of women suffering from preeclampsia with severe features. May be a form of preeclampsia. Preeclampsia occurs in 2–10% of pregnancies; it is more prevalent in women with diabetes, women who are obese, and older women. Perioperative Risks High maternal and fetal morbidity and…

Heart Disease, Congenital

Risk CHD is the most common birth defect. Incidence: 1:25 live births. 85–90% of pts with CHD survive to adulthood in USA due to advances in medical care. Perioperative Risks The highest risk factors of this complex disease include HLHS; poorly compensated physiology; presence of long-term complications (arrhythmia, pulm Htn, CHF); and emergency surgery. Intermediate risk factors include major surgery, age less than 2 y, preop…

Headache, Migraine

Risk Incidence in USA: >28 million; maximum prevalence is in 25–55 y of age. Can start as early as 1 y of age; 10–20% of instances occur in children by 20 y of age, with males and females being equally affected. More frequent in women after age 11 y; ratio is approx 3:1 for female: male; prevalence declines after age 40 y. Familial aggregation: CACNA1A (P/Q…

Hashimoto Thyroiditis

Risk Hashimoto thyroiditis is the most common cause of hypothyroidism in iodine-sufficient countries and primary hypothyroidism in adults. Incidence in USA: Approximately 100,000–400,000 new cases diagnosed each year. Causes thyroid failure in 10% of pts. Prevalence increases with age but it is also the most common cause of hypothyroidism in children as young as 1–2 y of age. Individuals between the ages of 30–50 y are…

Guillain-Barré Syndrome

Risk Occurs in both sexes, all races, all ages, but mostly affects young and middle-aged adults. Worldwide illness and occurs at all times of the year. Mortality rate is 3–7%; most pts eventually fully recover and 20% have significant residual weakness. Perioperative Risks Resp failure secondary to polyneuropathy Autonomic dysfunction with profound CV instability Worry About Rapidity of symptoms; respiratory paralysis may occur within 24 h…

Graves Disease

Risk Incidence: Approximately 5:10,000; prevalence: 1.12%, with 1.3 million pts in USA. Female-to-male ratio: 7:1; more common in women age 30–60 y. Family history indicating genetic factor(s) can be involved. Perioperative Risks “Thyroid storm” due to surge of plasma thyroid hormones Airway compromise due to hematoma compressing airway or nerve injury Hypocalcemia Cardiovascular complications: dysrhythmia, hemodynamic alterations Worry About Signs of airway obstruction, nerve injury Signs…

Gout

Risk Overall incidence: 0.05% in the USA population Most common inflammatory joint disease among men Associated with nephropathy, most commonly nephrolithiasis (10–40% of pts) Also associated with CV disease, specifically an increased risk of myocardial infarction, but also including heart failure, cerebrovascular accident, transient ischemic attack, and peripheral vascular disease Metabolic syndrome Hypertension Chronic renal dysfunction Perioperative Risk Medication toxicity and side effects Comorbid conditions associated…

Goodpasture Syndrome

Risk Incidence of 1 case per million people per y. Accounts for 20% of cases of RPGN or crescentic glomerulonephritis. In terms of bimodal age distribution, more common in males 20–30 y of age and females 60–70 y of age. Perioperative Risks Anemia from recurrent or persistent intrapulmonary hemorrhage Hypoxia or hypoxic respiratory failure in cases of massive intrapulmonary hemorrhage Rapidly progressive renal failure or uremia…