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Bronchiolitis Obliterans Syndrome

Acknowledgment We thank Dr. Roy Levitt for his previous contributions to this chapter. Risk Incidence in USA: 1:40,000 Racial predilection: None Occurs primarily after lung and hematopoietic stem cell transplantation Industrial workers exposed to inhalants who have presented with BOS: nylon-flock, battery workers, manufacturer of flavorings (diacetyl butter-like flavoring), and textile workers Perioperative Risks Hypoxemia and severe periop airway obstruction. Pulm infection, sepsis, and pulm edema…

Bronchiectasis

Acknowledgment The authors would like to acknowledge the contributions of Dr. H. Michael Marsh in this chapter’s previous edition. Risk Incidence in USA <1:10,000 hospital admissions. Cystic fibrosis is the single largest cause of bronchiectasis in industrial nations. A subgroup of Native Americans of Alaskan decent has a four-fold increase in the incidence of bronchiectasis over the general population. Ciliary deformities have been shown in a…

Brain Injury, Traumatic

Risk Incidence in USA: 1.7 million TBIs per year as of 2010, resulting in more than 280,000 hospitalizations and over 50,000 deaths. TBI is responsible for about 30% of all deaths due to injury. TBI, primarily from falls, has increased more than 50% in geriatrics from 2001 to 2010. Perioperative Risks Brain herniation Coagulopathy, DIC Metabolic derangement Worry About Occult cervical spine injury Other preexisting medical…

Brain Death

Risk Number of pts awaiting organ transplantation is much greater than the number of available solid organs Medical management affects the viability of organs for transplant Perioperative Risks Cardiovascular collapse Pulmonary edema Endocrine dysfunction Metabolic imbalance Coagulopathy Hypothermia Worry About Cardiovascular collapse and metabolic derangement limiting organ viability Overview Brain death is a clinical diagnosis in a comatose pt who has suffered terminal neurologic insult with…

Botulism

Risk Infant botulism. Wound botulism. Foodborne botulism. Adult intestinal toxemia. Injection botulism. Biological warfare/inhalational botulism (Category A biological threat). Incidence In USA, approximately 145 cases are reported each year: infant botulism 65%, wound 20%, and foodborne 15%; adult intestinal colonization and iatrogenic botulism rare. Foodborne outbreaks of two or more persons occur most years, and are usually caused by home-preserved foods with low-acid content (pH ≥4.6,…

Blindness

Risk Eye injuries represent 4% of claims analyzed in the ASA Closed Claims Project. Majority of entries in the ASA POVL Registry are associated with cardiac and spine cases, with a reported incidence as high as 4.5% and 0.2%, respectively. Other surgical procedures with POVL reported including head and neck, liver transplants, thoracoabdominal aneurysm resections, peripheral vascular procedures, and prostatectomies. In the Registry, POVL is most…

Bleomycin Sulfate Toxicity

Risk Pts with a history of germ cell tumors, lymphomas, squamous cell carcinomas, Kaposi sarcomas, and cervical cancers treated with BLM Incidence of BLT is 10–40%; mortality is 1–2% Risk of BLT increases with total dose >400 unit, glomerular filtration rate <80 mL/min, or advanced tumor stage at time of diagnosis History of concurrent thoracic irradiation cisplatin administration Age greater than 40 y History of smoking…

Blebs and Bullae

Risk Prevalence of blebs as high as 6% of young, healthy adults, although spontaneous rupture occurs only in 7.4 to 18 per 100,000. Incidence of ruptured bulla is 26 per 100,000. Increased incidence of primary disease in young males. Increased prevalence with smoking (Hx, including tobacco and illicit substances), COPD, chronic bronchitis, cystic fibrosis, lung cancer, staphylococcal pneumonia, tuberculosis, Marfan syndrome, Ehlers-Danlos syndrome, alpha-1 antitrypsin deficiency,…

Bipolar Disorder

Risk Lifetime prevalence within USA 4% Vast majority of pts younger than 25 y Suicide rates are 20 times higher than that of general population Perioperative Risks Risk of disregard for self care within manic phases, especially in the setting of enhanced stress Exacerbation of the disease if certain medications must be discontinued in the preop arena Anesthetic considerations focused on drug-drug interactions and altered dosing…

Bilirubinemia of the Newborn

Risk A common problem in neonates. Some types pathologic and some physiologic. Bilirubin may be unconjugated or conjugated; differentiating important for diagnosis. If pathologic, varying effect on management (e.g., sepsis, Rh incompatibility, GI obstruction, Gilbert, AVM, sickle cell, biliary atresia). Clinical, epidemiologic, and genetic risk factors associated with significant hyperbilirubinemia include preterm gestational age, exclusive breastfeeding, glucose-6-phosphate dehydrogenase deficiency, Rh/ABO incompatibility, East Asian or Native American…

Bernard-Soulier Syndrome

Risk Estimated to be <1 in 1 million persons, but may be higher due to misdiagnosis and underreporting Rare: Approximately 100 cases reported in literature Perioperative Risks Severe hemorrhage out of proportion to plt count Transfusion reactions Worry About Severe periop hemorrhage Limited availability of blood products Concurrent medical conditions (e.g., uremia, liver disease) or medications (NSAIDs, heparin, and antiplatelet agents) contributing to bleeding Overview Coagulopathy…

Behçet Disease

Risk Affects age group between 20–40 y Nations along Silk Route have higher incidence Males and females are equally affected Perioperative Risks Increase in IOP during intubation in pts with uveitis complicated by glaucoma Pulmonary embolism Difficult airway due to oral inflammation Worry About Difficult airway Hyperreactive skin Pulmonary aneurysm Intracranial Htn Concurrent anti-inflammatory medications Overview Multisystem inflammatory disorder of unknown etiology characterized by relapsing episodes…

Beckwith-Wiedemann Syndrome

Risk 1 per 13,700 individuals. No gender predilection, although with monozygotic twins it is seen more in females than males. Conceptions from IVF have a 3–5 times increased risk of BWS. Perioperative Risks Acute airway obstruction; difficult mask ventilation and intubation secondary to macroglossia Hypoglycemia due to islet cell hyperplasia and hyperinsulinemia Cardiac malformations Worry About Persistent hypoglycemia, which may cause CNS damage; therefore intraop infusion…

Becker Disease

Risk Prevalence is approximately 1:50,000 Perioperative Risks Myotonia Worry About Myotonic episode leading to a difficult to ventilate/intubate situation Overview Genetic disease that results in muscle membrane hyperexcitability and delayed relaxation Recessively inherited form of MC Initial symptoms start around 4–12 y of age, with generalized myotonia and moderate to pronounced muscular hypertrophy from chronically increased muscle activity Signs include muscle stiffness after voluntary contraction that…

Autonomic Dysreflexia

Risk AD occurs with greatest frequency in pts with spinal cord injury at T6 or above. Occurs with highest frequency following urologic or lumbar and thoracic spine procedures. Tetraplegic pts develop AD if cystoscopy and lithotripsy are performed without anesthesia. The higher the injury level, the greater clinical manifestations of CV dysfunction. Risk of AD greater with complete (91%) versus incomplete (27%) cord transections. AD more…

Autoimmune Diseases, Cold

Risk Rare Autoimmune hemolytic anemias occur in 1 of 80,000 persons; of these, 17.3% are due to cold antibodies. Perioperative Risks Acute hemolysis due to cold Hemoglobinemia Hemoglobinuria Rarely, vascular occlusion Worry About Cooling to 28–31° C will cause hemolysis. These temperatures can be reached in extremities during cardiopulmonary bypass. Overview In two circumstances antibodies will react in the cold to produce hemolysis: IgG antibodies associated…

Atrioventricular and Bifascicular Heart Block

Risk Prevalence: First degree (0.65–1.6%); second degree (0.003% in young adults; higher in organic heart disease); third degree (overall 0.02%; congenital 1:20,000 live births); increases with age presumably because of small vessel disease Inferior MI: Carries low mortality even if associated with high-degree AV block Anterior MI: If high-degree AV block results, then mortality approaches 80% Perioperative Risks Progression of benign heart block to second degree…

Atrial Septal Defect, Ostium Secundum

Risk Incidence in USA: 140,000 with ostium secundum ASD (70–80% of ASDs). Accounts for 7% of all congenital cardiac defects but roughly one-third (30–40%) of congenital cardiac defects in pts older than 40 y. Gender prevalence: Females >males, with a 2:1 ratio in isolated ASDs. Familial incidence: Significant if associated with P-R prolongation or forearm and hand abnormalities (Holt–Oram syndrome). Increased incidence in high altitude. Perioperative…

Atrial Septal Defect, Ostium Primum

Risk Ostium primum ASD is a variant of AV canal defect. Classified as an ASD, it is actually an endocardial cushion defect. Less common than secundum ASDs, this defect comprises 0.5-1% of all congenital heart defects, and 15-20% of ASDs. Approximately 50% of pts with primum ASD are female. Ostium primum is most commonly associated with the genetic defect trisomy 21 (Down syndrome). It is also…

Atrial Flutter

Risks AFLT occurs <1/10 as often as AFIB. Usually occurs in elderly pts with structural heart disease (those with LV dysfunction, RV dysfunction, pulm vascular disease, RHD, or CHD). Other risk factors include COPD, hypertension, obesity, and male sex. Occurs with relative frequency after cardiac surgery (peaks on postop d 2 to 4) but seldom after noncardiac surgery. Perioperative Risk Circulatory insufficiency or myocardial ischemia from…