By Robert N. Sladen, Douglas B. Coursin, Jonathan T. Ketzler, Hugh Playford
Anesthesia and Co-existing illnesses presents a well timed, fast review of universal and unusual co-morbidities which are encountered within the daily perform of anesthesiology. It offers a consultant to the perioperative review and anesthetic administration of sufferers with commonly everyday co-morbidities reminiscent of high blood pressure, diabetes, weight problems, myocardial ischemia, kidney and liver affliction. It concisely outlines priorities for sufferers with unique difficulties who're present process unrelated operative tactics, resembling the obstetrical sufferer, the sufferer with earlier organ transplantation, the grownup sufferer with congenital center affliction, the spinal wire injured sufferer, the melanoma sufferer with previous chemotherapy, the severely ailing sufferer or the sufferer with a psychiatric disease.
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Additional info for Anesthesia and Co-Existing Disease
Symptoms are related to decreased O2 delivery & if actively bleeding or inadequately compensated, degree of hypovolemia. 5; anemic if Hgb < 12 mg/dL r Pts living at altitude frequently have higher normal values secondary to hypoxia-induced increased erythropoiesis. r Smokers & those exposed to some environmental pollutants may have higher Hgb, which may approach polycythemic levels. r Some athletes may have higher baseline Hgb. r As pts age, some develop a physiologic anemia; however, need to rule out underlying pathology such as colon cancer, GI blood loss or other.
Abdominal pain, vomiting, diarrhea & hepatomegaly are all symptoms of carcinoid syndrome. ■ 8:52 P1: SBT 0521759385p2-B CUNY1088/Sladen 0 521 75938 5 Carcinoid Syndrome May 28, 2007 Chemotherapeutic Agents neuropsychiatric N/A CHEMOTHERAPEUTIC AGENTS JONATHAN T. KETZLER, MD overview Various combinations of chemotherapeutic agents are used to treat neoplasms. ■ Anesthesiologists must deal with pts whose organ systems have been impaired. ■ Categories of chemotherapeutic agents ➣ Alkylating agents r Nitrogen mustard r Cyclophosphamide Antimetabolites ➣ r Methotrexate Vinca alkaloids ➣ r Vincristine ➣ Antibiotics r Anthracyclines: doxorubicin (Adriamycin), daunorubicin, others r Bleomycin ➣ Enzymes r Asparaginase Synthetics ➣ r Cisplatin Hormones ➣ r Corticosteroids ■ fluids/electrolytes N/A cardiopulmonary ■ Cardiac toxicity 31 9:27 P1: SBT 0521759385p2-B 32 CUNY1088/Sladen 0 521 75938 5 May 28, 2007 Chemotherapeutic Agents ➣ Shock r Cardiogenic shock r Congestive heart failure r Anthracyclines; doxorubicin, daunorubicin, idarubicin, epirubicin, mitoxantrone r CHF that is refractory to cardiac glycosides is the hallmark.
Ivy bleeding time (BT) is prolonged >15 min (normal 3–8 min). metabolic-nutritional ■ Disordered metabolism ➣ Hyperglycemia (glucose intolerance) ➣ Hypertriglyceridemia ➣ Increased risk of atherosclerosis 43 9:27 P1: SBT 0521759385p2-B 44 CUNY1088/Sladen 0 521 75938 5 May 28, 2007 Chronic Renal Failure Protein malnutrition (kwashiorkor, hypoalbuminemic malnutrition) ➣ Albuminuria ➣ Dietary protein restriction ➣ Losses via CAPD (10–40 g/d protein) ■ Depleted lean body mass ➣ Catabolic effects of uremia ➣ Hypoalbuminemia, low colloid oncotic pressure (COP), interstitial & pulmonary edema ➣ Decreased functional residual capacity (FRC), ventilatory reserve ➣ Nosocomial & opportunistic infections (shunt or peritoneal catheter sites) ➣ Wound dehiscence, fistulas, bedsores ■ gastrointestinal Anorexia, hiccups, nausea & vomiting (hallmarks of acute uremia) ➣ Delayed gastric emptying ➣ Increased risk of regurgitation & aspiration ■ Mucosal inflammation, ulceration, bleeding (throughout GI tract) ■ Peptic ulcer disease (25% of pts despite regular dialysis) ➣ High incidence of hepatitis B and C ➣ Anicteric carrier state in pts on chronic hemodialysis ■ neuropsychiatric Wide range of CNS manifestations ➣ Subtle personality changes ➣ Drowsiness, asterixis, myoclonus, seizures ■ Acute encephalopathy ➣ Major surgery, GI bleeding or infection ■ Distal sensorimotor neuropathy ➣ Concomitant autonomic neuropathy likely (see below) ■ 9:27 P1: SBT 0521759385p2-B CUNY1088/Sladen 0 521 75938 5 Chronic Renal Failure May 28, 2007 Cocaine Toxicity ➣ Important indication for dialysis ■ Autonomic neuropathy Delayed gastric emptying Silent myocardial ischemia Orthostatic hypotension Impaired circulatory response to anesthesia ➣ ➣ ➣ ➣ COCAINE TOXICITY MARY E.
Anesthesia and Co-Existing Disease by Robert N. Sladen, Douglas B. Coursin, Jonathan T. Ketzler, Hugh Playford