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Anemia, Chronic Disease/Inflammation

Risk Incidence in USA: 5%; incidence in surgical population: 5% to 75%. Historically thought to be due to chronic infectious, inflammatory, or malignant conditions. Now known to occur with severe trauma, DM, aging, and acute immune activation. More than 130 million Americans living with chronic diseases. Perioperative Risks Risks related to underlying diseases Transfusion related risks (e.g., TRALI, TACO, hemolytic reactions, immunosuppression) Risks related to compensatory…

Anemia, Aplastic

Risk Incidence in USA: 2000 new cases Per million up to age 9. Southeast Asia and South Africa have 10-20 times higher incidence. Within USA, related to agricultural areas or petrochemical industry and chemical exposures. Perioperative Risks Infection Hemorrhage LV dysfunction due to high-output state and fluid overload Worry About Sepsis Coexisting congenital anomalies, especially renal and cardiac Concomitant GI and intracranial hemorrhage Difficulty cross-matching blood…

Anaphylaxis

Risk Lifetime prevalence of anaphylaxis is 0.05% to 2%, most common triggers being food, stings, and iatrogenic causes. Occurs in approximately 1 in 10,000 to 1 in 20,000 anesthetic procedures, and 1 in 6500 administrations of neuromuscular blocking agents (NMDAs). Causes 3% of anesthesia-related deaths. Females outnumber males 3:1. Hx of atrophy, prior anaphylaxis, and prior adverse reaction to anesthesia. Perioperative Risks Significant risks of life-threatening…

Amyotrophic Lateral Sclerosis

Risk Estimated incidence of 1-3:100,000. Mean age of onset is in the 60s, but ALS can occur as early as the 20s. Disease duration is approximately 3 y from the time of diagnosis to death. While there is slight male predominance of sporadic spinal ALS, slight female predominance is found in bulbar ALS Most cases are sporadic but 5% to 10% are familial. Risk of anesthesia…

Amyloidosis

Risk Incidence in USA: 1:100,000 Race with highest prevalence: Unknown Perioperative Risks Increased risk of periop renal failure, cardiomyopathy (arrhythmias and ventricular dysfunction), bleeding from coagulopathy Autonomic neuropathy Worry About Signs of CHF Dysrhythmias Decreasing urine output Overview Extracellular deposition of amyloid-type proteins. Congo-red stain of tissue reveals green birefringence in a polarizing microscope. Associated end-stage renal, myocardial, and neuropathic disease. Best diagnosed by subcutaneous abdominal…

Amniotic Fluid Embolism

Risk Risk factors include: advanced maternal age (>35 y); cesarean delivery; placenta previa; meconium; intrauterine fetal demise; placental abruption; meconium staining of the amniotic fluid; chorioamnionitis; and macrosomia. True incidence is unknown but estimated to occur in 2 to 8 per 100,000 deliveries. Perioperative Risks Amniotic fluid embolism accounts for approx 6% of maternal deaths in USA. Mortality was once as high as 61% to 86%,…

Alpha 1 -Antitrypsin Deficiency

Risk One of the most common inherited disorders (1 in 2500 in case of European ancestry; uncommon in Asians) Less than 10% of individuals with AAT deficiency are currently identified. AAT deficiency is the most common genetic cause of liver disease in neonates and children. About 1% to 5% of pts with COPD have AAT deficiency. Approximately 15% of adults with AAT deficiency develop liver cirrhosis.…

Allergy

Risk Incidence in USA: 5% of adults are allergic to one or more drugs. During surgery, the risk of anaphylaxis is ∼1:2500 to 1:20,000 depending on the agent, with a mortality rate of 4%. Females > males (1.6:1). Perioperative Risks Intensity of Sx variable: From an isolated cutaneous eruption to CV collapse and death. CV, cutaneous (incl angioedema), resp systems are mostly involved. Increased morbidity and…

Alcohol Abuse

Risk Incidence in USA: 10% of Americans, incl physicians, will abuse alcohol at some point in their lives. 1:5 surgical pts has some form of alcohol use disorder. Third leading cause of death and disability, incl 30% of traffic fatalities. Male gender and family Hx major are risk factors. Perioperative Risks Severe malnutrition as significant as ETOH-induced end-organ injury. Risk of Htn, CVA, diabetes, GI disease.…

Alagille Syndrome

Risk Also known as syndromic bile duct paucity Affects cardiac, musculoskeletal, ocular, facial, and neurodevelopmental systems Most common inherited disorder that causes chronic liver disease in children 1:100,000 births with equal gender incidence Perioperative Risks Cardiac congenital anomaly and hemodynamic instability Coagulopathy Liver dysfunction Musculoskeletal injury from positioning Worry About Vertebral abnormalities Facial anomalies Ocular abnormalities Vitamin deficiencies: A, D, E, K Neurologic deficits (neuropathy, mental…

Adrenal Insufficiency, Acute or Secondary

Risk Risk of adrenal insufficiency: 1/1000 to 1/10,000 (if steroids used in prior y). With steroids >20 mg/d (cortisol equivalent), >7 to 14 d within 1 y (large variability in pt response to dose, route(s), duration and timing of prior steroid use). Clinical signs worsen with stress, such as trauma, surgery, or infection. Perioperative Risks Increases CV instability, fever, CHF, lyte abnormalities. High cardiac output failure,…

Addison Disease

Risk Prevalence 1:100,000 persons M:F ratio: 1:1.8 Perioperative Risks CV instability, labile BP, hypotension, shock Hypovolemia, hyperkalemia, cardiac dysrhythmia Limited response to vasopressors Worry About N/V and diarrhea leading to dehydration, electrolyte imbalances, and acid/base disorder. Acute adrenal insufficiency leading to hypotension and refractory distributive shock. Cardiac dysrhythmia caused by hyperkalemia. Hypoglycemia and uremia, muscle weakness, decreased level of consciousness. Overview Addison disease is a specific…

Acute Respiratory Distress Syndrome

Risk Recent data estimates the incidence at 190,000 cases per year in USA. True incidence is unknown due to difficulty in defining the disease and making the diagnosis. Represents 10.4% of all ICU admissions and 23.4% of pts requiring mechanical ventilation per a recent 2016 publication. Mortality rates vary from 25% to 40%. Mortality rate is strongly influenced by associated conditions (e.g., higher when associated with…

Acute Intermittent Porphyria

Risk Prevalence: <200,000 cases of porphyria in USA, AIP: 5 to 10 in 100,000 worldwide. Highest in Northern Europeans. More commonly manifests in females, typically third to fourth decades of life. Perioperative Risks Drugs and/or chemicals that induce heme containing hepatic CYP450 enzyme (e.g., barbiturates, estrogens, smoking, alcohol). Induction of ALA synthase enzyme by fever or fasting. Psychological stress. Worry About Precipitation of acute crisis in…

Acromegaly

Risk People within USA: Prevalence is 40 cases/million; incidence is 3 to 8 new cases Occurs with equal frequency in men and women and most frequently diagnosed in third to fifth decades of life (5 to 20 y lag between onset of symptoms and diagnosis). Perioperative Risks Common conditions increasing periop risk include airway abnormalities, CV dysfunction (Htn), resp impairment (obstructive sleep apnea), endo abnormalities (hyperglycemia).…

Acquired Immunodeficiency Syndrome

Risk USA incidence of HIV: 50,000 per year USA prevalence of HIV: 1.2 million Sub-Saharan Africa prevalence: 25.8 million in 2014 USA prevalence of AIDS (HIV stages 3 and 4): 26,688 All but 8 were age 13 or older Perioperative Risk Susceptibility to infection Drug interactions Occupational exposure/viral transmission Overview AIDS is the clinical syndrome representing the late and more severe stages of infection with HIV.…

Acidosis, Renal Tubular

Risk Incidence in USA: Unknown Present in a variety of disease states, from mild to severe systemic illness Perioperative Risks Hemodynamic instability (related to arteriolar vasodilation, acidosis, and decreased cardiac output) Hyperkalemia Insulin resistance and hyperglycemia Acute respiratory failure Worry About Decreased responsiveness to vasopressors and inotropes Decreased activity of local anesthetic agents Arrhythmias Overview RTA is a type of metabolic acidosis that is due to…

Acidosis, Lactic/Metabolic

Risk Incidence in USA: Unknown Present in a variety of disease states, from mild to severe systemic illness Perioperative Risks Hemodynamic instability (due to arteriolar vasodilation and decreased cardiac output) Hyperkalemia Insulin resistance and hyperglycemia Stimulation of inflammation and suppression of immune response Acute resp failure Worry About Decreased responsiveness to vasopressors and inotropes Decreased activity of local anesthetic agents Arrhythmias You’re Reading a Preview Become…

Achondroplasia, Dwarfism

Risk 1 per 15,000 to 40,000 births worldwide Females ≥ males No race predilection Most common type of dwarfism Perioperative Risks Cervical spine instability Spinal cord compression Cardiopulmonary disease Worry About Difficult airway and ventilation Central and/or obstructive sleep apnea Cervicomedullary compression and foramen magnum stenosis Spinal cord and nerve root compression Restrictive lung disease Pulmonary hypertension, cor pulmonale Overview Results from overactive FGFR3, leading to…

Abruptio Placentae

Risk Occurs in 0.4-1% of pregnancies, and the incidence is increasing, particularly among African Americans. Associated with the following conditions: preeclampsia, hypertension, chorioamnionitis, cocaine use, alcohol use, trauma, increased age and parity, smoking, premature rupture of membranes, prior abruption, and multiple gestation. Perioperative Risks Maternal: Antepartum and postpartum hemorrhage, DIC, and death. Fetal: Hypoxia, prematurity, and fetal demise. Placental separation may lead to reduced gas exchange…