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Category: Comorbid Disease

Posted in: UIA > General Topics > Comorbid Disease 2020 Language: english

Perioperative myocardial ischaemia is an important entity with prognostic implications. Preoperatively, patients should have their perioperative risk clarified, and be optimised where time permits. • Intraoperative management consists of appropriate monitoring and anaesthetic technique, preventing myocardial oxygen supply-demand imbalances and identifying and treating intraoperative myocardial ischaemia. Postoperative considerations will depend on intraoperative events and the risk category of the patient, but may involve intensive monitoring and cardiology review.

Posted in: UIA > General Topics > Comorbid Disease 2014 Language: english

This article describes the differences between bare metal and drug eluting stents with the implications for duration of antiplatelet therapy. Up to 5% of patients with coronary stents require non-cardiac surgery within one year of placement and so it is important for anaesthetists to have a full understanding of the balance between stopping and continuing antiplatelet drugs.

Posted in: UIA > General Topics > Comorbid Disease 2009 Language: english

Human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS) are major global health concerns. The most recent WHO/UNAIDS report (2008) has estimated that there are 33 million people worldwide living with this infection, with 2.7 million new infections acquired in 2007. Given that approximately 25% of HIV- infected patients will require surgery during the time of their illness, it is important for anaesthetists to understand the implications of anaesthesia in the HIV- infected patient.

Posted in: UIA > General Topics > Comorbid Disease 2007 Language: english

Rheumatoid arthritis is a chronic inflammatory disorder. It is characterised by a chronic polyarthritis that primarily affects the peripheral joints and related periarticular tissues. It usually starts as an insidious symmetric polyarthritis, often with non-specific systemic symptoms.

Posted in: UIA > General Topics > Comorbid Disease 2007 Language: english

It is estimated that by 2010 cardiovascular disease will be the leading cause of death worldwide. In some countries more than 1 in 4 people suffer from some form of cardiovascular disease.

Posted in: UIA > General Topics > Comorbid Disease 2006 Language: english

Approximately 7% of the worldwide adult population is obese. Obesity is a global health problem and the prevalence varies with socio-economic status. In affluent cultures, the poor have the highest prevalence (27% of the US population and 17% of the UK population are obese). In the developing world it is the affluent that are at the highest risk. There is also a recent trend to an increasing prevalence of obesity in adolescents and children. Importantly 60-85% of obese schoolchildren will remain obese as adults.

Posted in: UIA > General Topics > Comorbid Disease 2006 Language: english

Atrial fibrillation (AF) is one of the commonest arrhythmias. It may be paroxysmal (sudden episodes), persistent or permanent. Atrial depolarization is very rapid, irregular and disorganized. This causes irregular and rapid ventricular conduction. AF may be seen in patients presenting for anaesthesia or may occur during anaesthesia.

Posted in: UIA > General Topics > Comorbid Disease 2004 Language: english

Chronic renal failure (CRF) and end stage renal disease (ESRD) are functional diagnoses characterised by progressive decrease in glomerular filtration rate (GFR). CRF occurs where GFR has been reduced to 10% (20ml/min) of normal function and ESRD when GFR falls below 5% (10ml/min). Patients with ESRD are dependant on renal replacement therapy (RRT) to survive. The relationship between serum creatinine and GFR is not linear (figure 1) and serum creatinine does not rise until GFR has fallen below 50%. In addition, renal tubular secretion of creatinine is increased at higher serum levels.

Posted in: UIA > General Topics > Comorbid Disease 2003 Language: english

Liver disease can vary in severity from sub-clinical to end- stage liver disease (ESLD), with life threatening, multi-organ multi-system failure. Anaesthetic and operative risks are related to the severity of liver dysfunction, so thorough pre-operative assessment is essential for safe peri-operative care. A good understanding of the pathophysiology of liver dysfunction is vital for assessment of operative risk.

Posted in: UIA > General Topics > Comorbid Disease 2003 Language: english

Over the past six decades, mortality due solely to anaesthesia has decreased from approximately 1 in 1,500 to 1 in 150,000. However, death within 30 days of surgery remains a major issue. In the United Kingdom, over the past ten years, the number of such perioperative deaths has remained fairly constant at approximately 20,000 deaths per annum 1 , of which 9,000 are due to cardiac causes.

Posted in: UIA > General Topics > Comorbid Disease 2003 Language: english

It has been about 50 years since the first case reports of perioperative shock due to secondary corticosteroid insufficiency. Since then it has been recommended that patients have adequate steroid replacement therapy to avoid perioperative haemodynamic instability. However there is a continuing debate over the amount of steroid that should be given. Some feel that only physiological amounts of steroids are necessary while others give much larger doses.

Posted in: UIA > General Topics > Comorbid Disease 2002 Language: english

Increasing numbers of elderly patients are presenting for surgery due to longer life expectancy. The incidence of peri-operative complications is much higher in these patients due to reduced functional reserve and a high incidence of co-morbidity, but these complications can be minimised by careful preoperative assessment, a meticulous anaesthetic technique and good postoperative care.

Posted in: UIA > General Topics > Comorbid Disease 2002 Language: english

Major surgery stresses the cardiovascular system in the perioperative period. This stress leads to an increase in cardiac output which can be achieved easily by normal patients, but which results in substantial morbidity and mortality in those with cardiac disease.

Posted in: UIA > General Topics > Comorbid Disease 2000 Language: english

Patients with respiratory disease have an increased chance of developing complications perioperatively. Most problems are seen postoperatively and are usually secondary to shallow breathing, poor lung expansion, basal lung collapse and subsequent infection. To minimise the risk of complications these patients should be identified preoperatively and their pulmonary function optimised.

Posted in: UIA > General Topics > Comorbid Disease 2000 Language: english

Diabetes is a condition where the cells of the body cannot metabolise sugar properly, due to a total or relative lack of insulin. The body then breaks down its own fat, proteinsand glycogen to produce sugar, resulting in high sugar levels in the blood (hyperglycaemia) with excess by-products called ketones being produced by the liver.

Posted in: UIA > General Topics > Comorbid Disease 2000 Language: english

Chronic Renal Failure (CRF) may be caused by primary renal disease or by systemic diseases which also affect the kidney. A decrease in nephron function occurs and can lead to a typical clinical pattern. CRF only becomes biochemically evident when less than 40% of the nephrons are functioning. Dialysis (either peritoneal or haemodialysis) is generally not required until less than 10% of nephrons are functioning. Patients with CRF are more likely to have associated atheroma formation and hypertension.

Posted in: UIA > General Topics > Comorbid Disease 1997 Language: english

The preoperative preparation and assessment is a vital part of the anaesthetic care given to patients scheduled for both routine and emergency surgery. All patients should be seen and assessed by the anaesthetist who is responsible for the administration of their anaesthetic.

Posted in: UIA > General Topics > Comorbid Disease 1994 Language: english

Haemoglobin (Hb) is contained in red blood cells and is capable of combining with oxygen in the lungs, transporting it to the tissues and releasing it there. Normally it is composed of 4 polypeptide chains combined with 4 haem radicals. When the haemoglobin is combined with oxygen it is said to be oxygenated . When it is not combined with oxygen it is deoxygenated (sometimes also called “reduced”).

Posted in: UIA > General Topics > Comorbid Disease 1992 Language: english

Hypertension is a common disease and patients with this condition frequently present for surgery. Most hypertensive disease is idiopathic (no cause known), but around 10% of patients suffer from hypertension caused by renal, endocrine or pregnancy related disease.