Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Cardiomyopathy, Ischemic

Epidemiology Approximately a 1:1000 incidence per y, increasing with age. M:F incidence ratio: 2:1. Most common cause of heart failure; accounts for 40% of all cases. Perioperative Risks CHF exacerbation Hypotension Pulmonary edema Myocardial ischemia/infarction Acute renal failure Malignant arrhythmias/pacemaker management with electrocautery LVEF, which is important for prognosis and periop complications but may not correlate with symptoms or exercise tolerance Worry About Acute heart failure…

Cardiomyopathy, Hypertrophic

Risk Relatively common inherited disorder; 0.2% or 1 in 500 Americans are affected. It is equally distributed between males and females and has no racial group predominance. The median age of clinical manifestation is 35 years, but it can manifest in any age. The clinical presentation is variable, reflecting a diverse genetic background. Pts may be totally asymptomatic or present with MI, CHF, arrhythmias, or even…

Cardiomyopathy, Dilated

Risk Accounts for approximately ∼10,000 deaths and ∼46,000 hospitalizations per year in USA; idiopathic DCM is one of the primary indications for cardiac transplantation. Often ages ∼20–60 y old but can affect older and younger pts as well. African-Americans > Caucasians; males > females Perioperative Risks CHF and dysrhythmias and hemodynamic instability. Morbidity and mortality directly related to severity of cardiomyopathy and complexity of surgery. Worry…

Cardiomyopathy, Alcoholic

Risk Incidence in USA: 15–20 million chronic heavy ethanol users. As much as 50% of dilated cardiomyopathy may be ethanol-related. Population at risk: Unclear; likely includes chronic ethanol users with at least 90 g of daily ETOH for at least 5 y (1 standard drink =12 g ETOH). Gender: Male predominance. Perioperative Risks Alcohol withdrawal CHF Dysrhythmias common: AFIB, PAC, PVC Hypomagnesemia and hypokalemia common Worry…

Cardiac Tamponade

Risk Overall incidence: 2 pts per 10,000 population 2% incidence due to trauma in penetrating injuries Post-cardiac surgery: Greater incidence after valve replacement (0.6%), compared to CABG (0.2%) Perioperative Risks Early diagnosis and prompt treatment are crucial in mitigating mortality and morbidity. Effusion can irritate myocardium, causing atrial and ventricular dysrhythmias. Regional cardiac tamponade is more common after cardiac surgery, where a localized effusion or hematoma…

Carcinoid Syndrome

Risk Carcinoid is the most common GI endocrine tumor. 15 cases in 1 million population per y. Seen in fewer than 20% of pts with carcinoid. Diagnosis Urinalysis for 5-HIAA and serotonin levels Platelet serotonin levels Serum chromogranin A CT scan and MRI Octreoscan and MIBG Perioperative Risks Associated with pt’s ability to tolerate abrupt hemodynamic change and/or bronchospasm Worry About Abrupt Htn or hypotension with…

Carbon Monoxide Poisoning

Risk CO is the predominant toxic gas in smoke. (COHb can reach 10% in tobacco smokers.) CO poisoning is a major cause of death (early symptoms may be only headache and dizziness). CO is produced by all internal combustion engines, incomplete oxidative combustion (e.g., house fires, charcoal and gas grills, malfunctioning butane/propane stoves), and endogenous sources (e.g., by the liver from exogenous exposure to paint stripper).…

Candidiasis

Risk Risk occurs in pts with suppressed immune systems from diseases like AIDS, chemotherapy drugs, and extended steroid therapy. Risk factors include current and recent broad-spectrum antibiotic therapy. Diabetes, leukemia, and neutropenia also increase risk. IV hyperalimentation and prolonged ICU stay increase risk. Risk increased via breaches of protective epithelial barrier: Surgical trauma, burn injury, long-term indwelling IV, or bladder catheters. Even in healthy individuals, candida…

Cancer, Lung Parenchyma

Risk Lung cancer is the primary cause of cancer death. Asbestos exposure increases risk 5-fold. Smoking increases risk 15-fold. Radon exposure increases risk 2-fold. Perioperative Risks Associated CAD Pulm insufficiency following lung tissue resection Worry About Optimization of preop pulmonary status Issues secondary to metastatic spread, such as superior vena caval syndrome Myasthenic syndrome (Eaton-Lambert) with oat cell carcinoma Massive hemoptysis with cancer invasion of bronchial…

Cancer, Esophageal

Risk Incidence in USA: 4.39:100,000 in white men, 2.0:100,000 in white women, 8.63/100,000 in African-American men, and 4.2:100,000 in black women. Adenocarcinoma more common in white men, while SCC highest in black men. Overall mortality rate is 4% (white) to 8% (black). Perioperative Risks Reflux as a risk of aspiration. Malnutrition with dehydration due to dysphagia. Periop arrhythmias occur in 20–60% of cases. Anastomotic leak most…

Cancer, Breast

Risk 100 times more common in women than men. Besides skin cancer, most common cancer in USA for women; 1 in 8 women develop breast cancer; a man’s lifetime risk is about 1 in 1000. Most significant risk factors for breast cancer are gender and growing older. About 2 out of 3 women with invasive breast cancer are 50 y or older when the cancer is…

Cancer, Bladder

Acknowledgement I wish to thank Dr. Andrew Dziewit for his work on this chapter in an earlier edition of this book. Risk Primary risk factor is smoking; smokers are more than twice as likely to get bladder cancer compared with nonsmokers. Incidence: males 37 per 100,000; females 9 per 100,000. No associated increased risk with alcohol or caffeine consumption. Median age of diagnosis: 73 y. Greater…

Calcium Deficiency/Hypocalcemia

Risk Common in critically ill pts and may be as high as 88% in ICU pts Perioperative Risks Neuromuscular instability leading to seizure, laryngospasm, bronchospasm, or resp arrest Impaired cardiac function causing heart failure, hypotension, and dysrhythmias Worry About Symptomatic hypocalcemia Overview Normal serum calcium content: 8.5–10.5 mg With 40–50% bound to plasma proteins (albumin). With 45–50% ionized (physiologically active). With 10–15% nonionized, bound to inorganic…

Burn Injury, Flame

Risk Flame injuries accounted for 43% of all burn cases from 2003 to 2012. 70,000 flame injuries requiring treatment over same 10-y period. Approximately 70% of injuries are accidental and nonwork related. Approximately 70% of injuries occur at home. Perioperative Risks Major predictors of mortality include BSA >40%, age >60, and presence of inhalation injury. Predicted mortality is 0.3%, 3%, 33%, or 90%, depending on presence…

Burn Injury, Electrical

Risk Low-voltage burns (<1000 V) commonly occur in children at home. High-voltage burns (≥1000 V) are more common in adults and characteristically occur in outdoor environments near power sources and lines. Lightning electrical burns carry highest rate of mortality and usually have energy >30 million volts. Perioperative Risks Pts with an acute burn or a history of burns may present an additional challenge to securing the…

Burn Injury, Chemical

Risk From 1999 to 2008, 3% of all reported burn injuries. Risk increases with age: 1% of burn injuries from birth to age 16; 3.7% from 20–30; and 5% from 30–50, according to the National Burn Repository Report on Data from 1999 to 2008. Majority of chemical exposures occupational, occurring in men of working age, whereas assaults with caustic chemicals are more likely to occur against…

Bulimia Nervosa

Risk Prevalence ranges from 3–30% among women aged 15–30 y. Bulimic symptoms can be part of the anorexia nervosa syndrome. The bulimic type is more damaging than anorexia nervosa as the combination of vomiting, laxative abuse, and malnutrition can lead to global organ dysfunction. Perioperative Risks Increased risks (which have not been quantified) of hypotension, cardiac arrhythmias, hypothermia, aspiration of gastric contents, and metabolic abnormalities and…

Buerger Disease (Thromboangiitis Obliterans)

Risk Current or recent chronic tobacco/nicotine exposure Ashkenazi Jewish ethnicity; prevalence much greater in Eastern Europe, Southeast Asia, and India Age <45, male gender (M:F ratio: 10–100:1) Incidence in USA: Progressively decreasing in association with decreasing smoking prevalence; <8–10/100,000 Perioperative Risks Similar to any pt with chronic tobacco exposure Risks to already compromised perfusion of distal extremities Worry About Coexisting pulm disease in tobacco smokers Abnormal…

Bronchopulmonary Dysplasia

Risk Incidence in USA: 10,000-15,000 infants annually Risk increases with decreasing gestational age and birth weight Affects at least one-quarter of infants with birth weights <1500 g No race or gender predilection Perioperative Risks Bronchospasm Pulm Htn Cor pulmonale Worry About Airway obstruction and hyperreactivity Pulm Htn and cor pulmonale “BPD spells”: Acute cyanotic events caused by increases in central airway resistance Tracheomalacia and/or bronchomalacia Recurrent…

Bronchitis, Chronic

Risk Incidence in USA: 14 million Race with highest prevalence: Caucasian M:F ratio 1:2 Smoking, second-hand smoke, occupational exposure to pulm toxic substances (radon, coal, silicates, and asbestos) Perioperative Risks Bronchospasm Worry About Airway stimulation at light levels of anesthesia Laryngospasm (due to secretions and hyperreactivity) Hypoxia Hypercarbia Overview Chronic productive cough with periodic exacerbations (most d for at least 3 mo and for at least…