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Cleft Palate

Risk 1 per 800 live births Frequently associated with cleft lip Gender predominance: Cleft lip/palate more common in males (2:1); isolated cleft palate more common in females (3:1) Perioperative Risks Morbidity and mortality extremely low; only five life-threatening cases of postop airway obstruction described in the literature. Worry About Difficult airway with associated anomalies of head and neck as in syndromes such as Shprintzen, 4P, or…

Cigarette Smoking Cessation

Risk In USA, approximately 21% of adults smoke tobacco; prevalence varies inversely with socioeconomic class; men > women (26% vs. 15%). Minorities more likely to smoke and less likely to quit. Prevalence among adults and teens declining, but growing evidence that teens using electronic cigarettes may be more likely to try other tobacco products. Perioperative Risks Current smokers at increased risk of pneumonia, sepsis, unplanned intubation,…

Cigarette Smoking

Risk Smoking is the most common cause of preventable death. Half of cigarette smokers die of a smoking-related disease; on average, smokers lose at least 10 y of life expectancy. In USA, incidence of smoking is 17.8%: 42.1 million smokers (2013). Consumption in USA peaked in 1965 at 42%. Worldwide consumption still rising, with 5.8 trillion cigarettes smoked per y; fastest consumption growth is in China.…

Churg-Strauss Syndrome

Risk Rare: 2–5 new cases/million/y Average age of onset: 35–50 y Male = female Perioperative Risks Necrotizing eosinophilic vasculitis involving respiratory (100% of pts), cardiac (30–60% of pts), neurologic, GI, renal, and integumentary systems Worry About Respiratory complications from severe asthma exacerbations CV collapse from coronary artery vasculitis, myocarditis, or cardiac tamponade; represents the major cause of mortality Peripheral and central neurologic defects (mononeuritis multiplex and…

Chiari Malformations

Risk 1:1000 live births Increased use of MRI leading to greater diagnosis Chiari malformation types I and II: Most common pediatric hindbrain abnormality Chiari type II always accompanied by myelomeningocele (which occurs in 0.6 of 1000 live births) Perioperative Risks Respiratory and gastrointestinal dysfunction OSA, which has been targeted as an independent risk factor in perioperative morbidity, regardless of type of procedure Herniation Worry About Increased…

Cherubism

Risk >250 cases in world literature Cherubs have a 40% chance of having a cherub offspring Perioperative Risks Swelling of lower face causing airway obstruction Displacement of ocular orbit and lower eyelid, causing visual changes Excessive blood loss from curettage of vascular lesions Association with Noonan syndrome Worry About Pulm valve stenosis (Noonan syndrome) Undiagnosed hyperparathyroidism Convex, V -shaped hypertrophied hard palate Small mouth opening and…

CHARGE Association

Risk Newborns: 1 in 10,000 Perioperative Risks Respiratory failure in the neonate (due to choanal atresia) Difficult airway (cleft lip and palate and tracheomalacia) Aspiration risk Congenital heart disease Worry About If pt has respiratory insufficiency, consider subglottic stenosis. Postop respiratory failure. Overview The term CHARGE was coined in 1981 to describe pts with coloboma, congenital heart defects, choanal atresia, retardation of growth and/or other development,…

Charcot-Marie-Tooth Disease

Risk Incidence: 1:2500 people Peripheral disease severity varying from mild to severe autonomic, motor and sensory neuropathy Perioperative Risks Potential for postop weakness, especially following nondepolarizing neuromuscular blocking agents Worry About Resp insufficiency secondary to diaphragmatic or phrenic nerve dysfunction Preexisting vocal cord palsy or paralysis Secondary nerve entrapments or injuries with intraop positioning Overview Peripheral neuropathy is caused by peripheral demyelination (altered myelin function or…

Chagas Disease

Risk 16–18 million people infected worldwide Rare in southern USA; chronic disease more likely in immigrants from endemic regions (South America, central Brazil prevalence 6–8%) More than 50,000 die each year; mortality estimated at 50% at 4 y secondary to heart failure Higher risk to laboratory workers and personnel exposed to blood products, travelers to endemic areas Perioperative Risks Not defined. Most important prognostic factor is…

Cervical Disk Disease (Cervical Spine Disease)

Risk Incidence in USA: 12,000 deaths/y; 70 million with cervical disk disease, spondylosis, or trauma Disk disease a consequence of aging (3rd-5th decades) Present in RA, ankylosing spondylitis, and other rheumatic disorders Trauma, especially motor vehicle accidents M:F ratio: 3:2 Perioperative Risks Mortality (acute) 1–5% (depending on associated injuries) Spinal cord damage with C-spine movement Difficulty intubating or reintubating postextubation Swelling or hematoma after neck surgery,…

Cerebrovascular Transient Ischemic Attack

Risk Overall incidence in USA: Approximately 1.1 per 1000. Risk related to demographic factors: Age, gender, and race. Estimated prevalence of TIA in men is 2.7% versus 1.6% in women ages 65–69 y, and 3.6% in men versus 4.1% in women ages 75–79 y. The overall prevalence is estimated to be 0.4% among adults 45–64 y. African Americans and Hispanics at higher risk than Caucasians. Perioperative…

Cerebral Palsy

Risk Leading cause of childhood motor disability: 2–2.5 per 1000 live births in developed countries. Incidence has not decreased despite improved perinatal care due to increased survival in premature neonates. Cerebral palsy pts undergo surgery at higher rates due to frequent comorbidities. Perioperative Risks Dehydration Electrolyte imbalance Hypothermia Delayed recovery Hypotension Seizure Worry About Difficult intubation GE reflux and aspiration Associated respiratory impairment and hypoxemia Drug…

Cerebral Arteriovenous Malformations

Risk Cerebral AVMs are rare: 1–2% cause of CVA in a younger population; mean age of diagnosis is 31 y. 55% of pts are men. Symptomatic cases: 1:100,000 per y. Found in 4.3% of population at autopsy. Of those affected, 45–70% present with hemorrhage, 30% with seizures, 12% with persistent neurologic deficits, and 1% with headaches. Yearly risk of hemorrhage is 1–3%. Perioperative Risks Risk of…

Cephalopelvic Disproportion

Risk Occurs in 1–3% of the pregnant population Perioperative Risks Increased maternal and fetal morbidity and mortality Protracted labor Arrested labor Uterine rupture Increased rate of cesarean section Increased rate of forceps- or vacuum-assisted delivery Worry About Increased need for surgical delivery Increased incidence of fetal distress and need for emergency intervention You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy…

Central Neurogenic Hyperventilation

Risk True CNH is exceedingly rare; the exact incidence is unknown. In pts with neurologic injury, it is most often associated with pulm dysfunction or shunting (aspiration, pneumonia, pulm edema, and baseline disease). Primarily seen in comatose pts. No association with age or gender. Overview A diagnosis of exclusion in neurologic disorders and in cases of hyperventilation; life-threatening causes of hyperventilation (hypoxemia, ischemic bowel, and acidosis)…

Carpenter Syndrome (Acrocephalopolysyndactyly Type II)

Risk Extremely rare; global estimate: 1:1,000,000 births Over 100 reported cases Perioperative Risks Airway obstruction Difficult mask ventilation and/or difficult intubation Increased ICP from craniosynostosis Coexisting congenital anomalies, especially cardiac Overview Manifestation: Craniosynostosis Polysyndactyly Cardiac defects Obesity Maxillary or mandibular hypoplasia Craniosynostosis usually with metopic and sagittal sutures (midline suture fusion) Cardiac defects in up to 50% of cases (tetralogy of Fallot, transposition of great vessels,…

Carotid Sinus Syndrome

Risk Male > female 9% of pts with recurrent syncope; history of falls Increased incidence with age, rarely below age 50 y Peripheral vascular disease Head and neck cancer Perioperative Risks Presence of CSS does not increase rate of mortality, sudden death, or stroke more when compared with pts with similar age and risk factors. CSS does increase morbidity, secondary to injuries sustained during syncopal episodes.…

Carnitine Deficiency

Risk Rare (1:40,000 in Japan) Perioperative Risks Hypoglycemia triggered by fasting Massive rhabdomyolysis and cardiac arrest described following GA and succinylcholine. (The response may be confused with malignant hyperthermia.) No evidence that susceptibility to malignant hyperthermia is associated with the carnitine palmitoyltransferase enzyme system Worry About Periop hypoglycemia: Avoid prolonged fasting; IV glucose should be administered Neurologic and cardiopulmonary status: Determine if a cardiomyopathy is present…

Cardiomyopathy, Restrictive

Risk About 5% of all primary cardiomyopathies. Idiopathic type is rare, and may be familial. 50% of pts with AL-type amyloidosis are affected. Endomyocardial fibrosis is endemic in Africa, Asia, and Central and South America. Perioperative Risk Diastolic dysfunction and low cardiac output state. Right heart failure with ascites and congestive hepatomegaly. Left heart failure with pulmonary edema. Cardiac arrhythmias, especially atrial fibrillation, ventricular arrhythmias, and…

Cardiomyopathy, Peripartum

Risk Exact incidence unknown Incidence in USA: About 1:3000 to 1:4000 live births Incidence higher in African-Americans compared to Caucasians Highest incidence in Haiti and parts of Africa Perioperative Risks CHF Arrhythmias; atrial and ventricular Pulm and systemic thromboembolism Worry About Increased myocardial oxygen demand with progression of pregnancy may exceed myocardial oxygen supply resulting in myocardial ischemia. Autotransfusion associated with uterine contractions during labor and…