Anesthesia and Co-Existing Disease by Robert N. Sladen, Douglas B. Coursin, Jonathan T. Ketzler,

By Robert N. Sladen, Douglas B. Coursin, Jonathan T. Ketzler, Hugh Playford

Anesthesia and Co-existing illnesses presents a well timed, swift evaluate of universal and unusual co-morbidities which are encountered within the day by day perform of anesthesiology. It presents a advisor to the perioperative evaluate and anesthetic administration of sufferers with extensively conventional co-morbidities similar to high blood pressure, diabetes, weight problems, myocardial ischemia, kidney and liver disorder. It concisely outlines priorities for sufferers with distinct difficulties who're present process unrelated operative strategies, corresponding to the obstetrical sufferer, the sufferer with earlier organ transplantation, the grownup sufferer with congenital middle disorder, the spinal twine injured sufferer, the melanoma sufferer with earlier chemotherapy, the severely sick sufferer or the sufferer with a psychiatric illness.

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Cardiopulmonary ■ Systolic dysfunction ➣ Systolic wall motion abnormalities, localized w/ CAD, global w/ cardiomyopathy ➣ Ventricular dysrhythmias common ➣ Chronic hypertension produces pressure overload; valvular regurgitation may produce volume overload. ➣ Hallmark: reduced LV EF (reflects severity of disease; mea- ■ ■ ■ ■ sured w/ echocardiography, ventriculogram or radionuclide scanning) ➣ LV dysfunction implies EF < 45% w/ or w/out symptoms Diastolic dysfunction ➣ Age-dependent (<15% of pts <45 yrs, 35% of pts >65 yrs) ➣ Hallmark: impaired ventricular relaxation ➣ May have symptoms w/ normal systolic function ➣ Higher filling pressures are required, which reflect back on the pulmonary system, causing pulmonary congestion & pulmonary edema depending on severity.

0 cm2 ) ■ ■ 25 8:52 P1: SBT 0521759385p2-A 26 CUNY1088/Sladen 0 521 75938 5 Aortic Stenosis ■ May 28, 2007 Bronchospastic Disease Acute decompensation (low cardiac output syndrome) ➣ Acute atrial fibrillation, tachyarrhythmias (loss of atrial kick) ➣ Late manifestations ➣ Congestive heart failure ➣ Sudden death ■ Increased risk of perioperative myocardial ischemia ➣ Acute ischemia w/ relatively mild perturbations ➣ Low cardiac output syndrome (unable to respond to postop demands) ➣ Cardiac arrest: CPR may be unsuccessful in overcoming LVOT obstruction hematologic N/A metabolic/nutritional N/A gastrointestinal N/A neuropsychiatric N/A BRONCHOSPASTIC DISEASE HUGH PLAYFORD, MD overview N/A fluids and electrolytes ■ ■ Usually normal Chronic systemic steroid use may lead to fluid retention, hypernatremia, hypokalemia.

Polyuric chronic renal failure (CRF) ➣ Urine output “normal”, but concentrating ability absent ➣ Fluid loss quickly results in hypovolemia. 5 mEq/L. Acute hyperkalemia ➣ Catabolic stress, acidosis ➣ K-sparing diuretics ➣ Red blood cell (RBC) transfusion ➣ K replacement Hyperkalemia ➣ Asystolic arrest (may occur w/out ECG prodrome) Hypermagnesemia ➣ Muscle weakness ➣ Increased susceptibility to muscle relaxants Hyperphosphatemia ➣ Renal osteodystrophy Excessive dialysis can result in K, Mg & phosphate depletion.

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