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Skin and Bone Disorders

Key Points ▪ Achondroplasia frequently makes airway management difficult for patients, and unstable cervical spine anatomy presents the risk of neurologic injury. Postoperative respiratory insufficiency may be a challenge. ▪ Behçet's disease is associated with a variety of cardiovascular diseases with anesthetic implications. Lesions around the airway can make intubation difficult, and airway obstruction may require anesthetic intervention. ▪ Epidermolysis bullosa patients present with fragile skin…

Muscle Diseases

Key points ▪ Patients with muscular diseases have a postoperative pulmonary complication rate of 25% to 48%. Their inability to take deep inspirations and cough predisposes them to atelectasis and pneumonia. ▪ Muscular dystrophies have variable modes of inheritance and clinical presentation, characterized by progressive muscle weakness and often associated with global systemic effects. ▪ Both cardiac and respiratory complications are major determinants of quality of…

Neurologic Diseases

Key points ▪ Hereditary motor and sensory neuropathies (HMSNs) are disorders of myelination of the peripheral nervous system resulting in progressive loss of motor and sensory function. ▪ In familial dysautonomia (HSAN-III), anesthesia management is directed at prevention and prompt treatment of dysautonomic crises. ▪ Multiple system atrophy is a new term synonymous with Shy-Drager syndrome, striatonigral degeneration, and olivopontocerebrellar atrophy. ▪ Parkinson's disease symptoms include…

Renal Diseases

Key points ▪ The presence of chronic or acute kidney disease has significant negative effects on surgical outcomes. Knowledge of key pathophysiologic aspects of glomerular and tubular disorders is a key component to optimal perioperative management of renal patients. ▪ Coexisting renal disease greatly affects management of other systems. Kidney disorders can result from systemic illness and invariably compromise other organ systems; renal patients are at…

Obesity and Nutrition Disorders

Key points ▪ Obesity is a common disease. The number of overweight, obese, and morbidly obese persons has increased alarmingly in the last three decades. ▪ Body mass index (BMI) is only one measure of obesity; some patients with high BMI are in good health. ▪ Distribution of fat is a better predictor of health risk than weight alone; gynecoid (gluteofemoral) fat distribution predicts better risk…

Liver Diseases

Key Points ▪ The liver receives a dual afferent blood supply; the portal vein provides 75% and the hepatic artery 25% of hepatic inflow. With differences in oxygen content, each source contributes about 50% of the liver's oxygen supply. ▪ Hepatocytes make up 80% of the liver. Nonparenchymal cells include Kupffer cells, members of the monocyte-phagocyte system that play a key role in immunity. Stellate cells…

Respiratory Diseases

Key points ▪ Pulmonary arteriovenous fistulas have congenital and hereditary etiology, and patients are at risk for life-threatening rupture requiring surgery. ▪ Wegener's granulomatosis can affect any organ system, although renal and pulmonary involvement is most common; men ages 40 to 50 are at increased risk. ▪ Lymphomatoid granulomatosis affects cardiopulmonary, neurologic, and myeloproliferative systems; may result from opportunistic infection, and frequently progresses to lymphoma; men…

Congenital Heart Disease

Key points ▪ Congenital heart disease (CHD) is the most common birth defect requiring invasive treatment. ▪ With improved medical, surgical, and perioperative care, about 1 million children and 1 million adults now live with CHD. ▪ Although relatively uncommon in the general population, anesthesiologists must understand which CHD patients are at higher anesthetic risk and plan perioperative care accordingly. ▪ The patient with CHD is…

Cardiac Diseases

Key points ▪ Even the most uncommon cardiac diseases are characterized by common and classifiable patterns of cardiac physiology and pathophysiology. ▪ Knowledge of disease effects on determinants of cardiac function allows the practitioner to select appropriate anesthetic drugs and techniques based on the common patterns of cardiac pathophysiology. ▪ Appropriate hemodynamic monitoring guides treatment options and allows for early intervention should hemodynamic instability occur. Intra-arterial…

Eye, Ear, Nose, and Throat Diseases

Key points ▪ During ophthalmic surgery, the anesthesiologist is often positioned away from the patient's face, preventing immediate access to the airway, and during many laryngologic surgeries, must share the airway with the surgeon. These logistical exigencies can compromise patient safety. ▪ Patients with eye conditions are often at the extremes of age and may have extensive associated systemic processes or metabolic diseases. ▪ Patients requiring…

V

Va-Vc Vacuum insulated evaporator (VIE). Container for storage of liquid O 2 and maintenance of piped gas supply . An outer carbon steel shell is separated by a vacuum from an inner stainless steel shell that contains O 2 . The inner temperature varies between −160°C and −180°C, at a pressure of 7–10 bar . Gaseous O 2 is withdrawn and heated to ambient temperature (and…

T

T-Tc t 1/2 see Half-life T-piece breathing systems see Anaesthetic breathing systems t tests see Statistical tests T wave Wave on the ECG representing ventricular repolarisation ( see Fig. 60b ; Electrocardiography ). Normally upright in leads I, II and V 3–6 ; the upper height limit is 5 mm in the standard leads and 10 mm in the chest leads. Abnormalities: ◗ may be inverted in myocardial…

S

S-Sa S-100β protein Calcium -binding protein present in glial cells, studied as an early marker of damage to the blood–brain barrier , e.g. after stroke , TBI , cardiac surgery and neurosurgery . A normal level reliably excludes significant CNS injury. After moderate or severe TBI, raised levels reliably predict poor short- and long-term prognosis. Metabolised in the kidney with a half-life of ~25 min, the serum…

R

Rr-Ra R on T phenomenon Arises when the R wave of a ventricular ectopic beat falls on the T wave of the preceding beat. At the middle of the T wave, the myocardium is partly depolarised and partly repolarised, and thus vulnerable to establishment of re-entrant and circulatory conduction, leading to VF or VT . R wave First upward deflection of the QRS complex of the…