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

Nonfiction 4

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

Anesthesia and Co-existing ailments offers a well timed, speedy assessment of universal and unusual co-morbidities which are encountered within the daily perform of anesthesiology. It offers a consultant to the perioperative evaluation and anesthetic administration of sufferers with broadly typical co-morbidities resembling high blood pressure, diabetes, weight problems, myocardial ischemia, kidney and liver ailment. It concisely outlines priorities for sufferers with unique difficulties who're present process unrelated operative systems, similar to the obstetrical sufferer, the sufferer with earlier organ transplantation, the grownup sufferer with congenital center sickness, the spinal twine injured sufferer, the melanoma sufferer with previous chemotherapy, the seriously in poor health sufferer or the sufferer with a psychiatric affliction.

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KETZLER, MD overview ■ ■ ■ ■ ■ ■ Cor pulmonale: right ventricular (RV) enlargement secondary to pulmonary hypertension Third most common cardiac disorder in persons >50 yrs Male:female = 5:1 Exhibited in 10–30% of hospitalized pts w/ CHF COPD is the most common cause. COPD causes pulmonary capillary loss & arterial hypoxemia leading to pulmonary vasoconstriction. If hypoxemia is sustained, pulmonary medial hypertrophy occurs, leading to irreversible pulmonary hypertension.

Significant deconditioning, particularly of respiratory muscles ■ gastrointestinal Minimal change neuropsychiatric Minimal change CHRONIC RENAL FAILURE ROBERT N. SLADEN, MD overview ■ Chronic renal disease ➣ Chronic renal insufficiency (CRI) ➣ End-stage renal disease (ESRD) (dialysis-dependent) ■ Etiology ➣ Primary (nephropathy) ➣ Secondary (diabetes, hypertension, SLE, vasculitides) ■ Dialysis ➣ Hemodialysis (HD) (about 85% of pts) ➣ Chronic ambulatory peritoneal dialysis (CAPD) fluid and electrolytes Metabolic acidosis, hyperkalemia & congestive heart failure (CHF) ➣ Well controlled by dialysis ■ Anuric pts ➣ Fluid loss is insensible only, about 500 mL/d.

Metabolic-nutritional ■ ■ Tryptophan depletion is associated w/ serotonin release. Pellagra can result from carcinoid syndrome. gastrointestinal Most tumors are GI ➣ 50% appendix ➣ 25% ileum (usually source of metastases) ➣ 20% rectum ■ Liver metastases have direct access to systemic circulation to release hormones & produce syndrome. ■ Serotonin causes increased motility. ■ 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.

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