By Robert N. Sladen, Douglas B. Coursin, Jonathan T. Ketzler, Hugh Playford
Anesthesia and Co-existing ailments presents a well timed, quick evaluation of universal and unusual co-morbidities which are encountered within the day by day perform of anesthesiology. It presents a advisor to the perioperative overview and anesthetic administration of sufferers with broadly generic co-morbidities corresponding to high blood pressure, diabetes, weight problems, myocardial ischemia, kidney and liver illness. It concisely outlines priorities for sufferers with specified difficulties who're present process unrelated operative strategies, akin to the obstetrical sufferer, the sufferer with previous organ transplantation, the grownup sufferer with congenital middle ailment, the spinal wire injured sufferer, the melanoma sufferer with previous chemotherapy, the seriously in poor health sufferer or the sufferer with a psychiatric disease.
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Additional resources for Anesthesia and Co-Existing Disease
R 5-Fluorouracil r May induce coronary artery spasm within minutes to hrs after dosing r Pericarditis r Anthracyclines (rare) r Radiation r Approx. 50% of cases of thoracic radiation r Typically occurs 6 months to 2 yrs after treatment r Can also cause cardiac ischemia, fibrosis & tamponade 9:27 P1: SBT 0521759385p2-B CUNY1088/Sladen 0 521 75938 5 May 28, 2007 Chemotherapeutic Agents r Cardiac dysrhythmias r Cyclophosphamide, 5-fluorouracil, ifosfamide, amsacrine, Taxol, doxorubicin, interleukin-2 r Distributive shock r Pancreatitis r L-asparaginase r Treat w/ glucocorticoids.
50% of cases of thoracic radiation r Typically occurs 6 months to 2 yrs after treatment r Can also cause cardiac ischemia, fibrosis & tamponade 9:27 P1: SBT 0521759385p2-B CUNY1088/Sladen 0 521 75938 5 May 28, 2007 Chemotherapeutic Agents r Cardiac dysrhythmias r Cyclophosphamide, 5-fluorouracil, ifosfamide, amsacrine, Taxol, doxorubicin, interleukin-2 r Distributive shock r Pancreatitis r L-asparaginase r Treat w/ glucocorticoids. r Addisonian crisis r Glucocorticoid withdrawal r Septic shock r Busulfan, carboplatin, carmustine (BCNU), cyclophosphamide, cytarabine, etoposide, fludarabine, idarubicin, ifosfamide, melphalan, mercaptopurine, methotrexate, mitomycin, procarbazine, thiotepa, topotecan, doxorubicin r Due to prolonged myelosuppression r Anaphylaxis r Carboplatin, cisplatin, cytarabine, etoposide, Lasparaginase, melphalan, methotrexate, mitomycin, pentostatin, procarbazine, teniposide r Hypovolemic shock r Cyclophosphamide, ifosfamide r Hemorrhagic cystitis ■ Pulmonary toxicity ➣ Chronic pneumonitis, pulmonary fibrosis r Offending drugs r Azathioprine, bleomycin, busulfan, carmustine, chlorambucil, cyclophosphamide, melphalan, methotrexate, mitomycin C r Clinical findings r Bibasilar “Velcro-like” rales r Hypoxemia, respiratory alkalosis.
Impaired myocardial oxygen balance (MVO2 ) ➣ Increased demand (increased afterload, contractility) ➣ Decreased supply (decreased aortic diastolic pressure, thickened myocardium) ➣ Angina may occur w/out coronary artery disease (CAD). 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.