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

Anesthesia and Co-existing illnesses offers a well timed, speedy evaluation of universal and unusual co-morbidities which are encountered within the day by day perform of anesthesiology. It offers a consultant to the perioperative evaluation and anesthetic administration of sufferers with broadly general co-morbidities resembling high blood pressure, diabetes, weight problems, myocardial ischemia, kidney and liver affliction. It concisely outlines priorities for sufferers with specific difficulties who're present process unrelated operative systems, reminiscent of the obstetrical sufferer, the sufferer with earlier organ transplantation, the grownup sufferer with congenital center disorder, the spinal wire injured sufferer, the melanoma sufferer with past chemotherapy, the significantly sick sufferer or the sufferer with a psychiatric disease.

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Pts often present to hospital w/ FEV1 <35% of normal, or maximal mid-expiratory flow rate <20% of normal. When FEV1 returns to about 50%, symptoms decrease markedly. ➣ Flow-volume loop: downward scooping of the expiratory limb of the loop ➣ Between asthma attacks, FRC may be increased by 1–2 L, but TLC remains normal. ➣ DLCO usually unchanged ➣ ABG (between attacks): often normal 27 8:52 P1: SBT 0521759385p2-A 28 CUNY1088/Sladen 0 521 75938 5 May 28, 2007 Bronchospastic Disease ➣ ABG (mild asthma attacks): decreased PaCO2 & respiratory alkalosis ➣ ABG (worsening airflow limitation): decreased PaO2 (from increasing ventilation-perfusion mismatch) & increased PaCO2 (fatigue w/ increased work of breathing) ➣ Chest x-ray: important in excluding other causes of respiratory failure; often normal but may have hyperinflation ➣ ECG: may have right axis deviation & ventricular irritability (beta-2 agonists, acidemia) ■ Related to therapy ➣ Beta-2 agonists: sympathetic stimulation, tachycardia, cardiac dysrhythmias ➣ Methylxanthines (eg, theophylline): cardiac dysrhythmias hematologic ■ ■ Usually normal May be associated w/ an eosinophilia ➣ Eosinophilia may parallel the degree of airway inflammation & airway hyperreactivity.

When FEV1 returns to about 50%, symptoms decrease markedly. ➣ Flow-volume loop: downward scooping of the expiratory limb of the loop ➣ Between asthma attacks, FRC may be increased by 1–2 L, but TLC remains normal. ➣ DLCO usually unchanged ➣ ABG (between attacks): often normal 27 8:52 P1: SBT 0521759385p2-A 28 CUNY1088/Sladen 0 521 75938 5 May 28, 2007 Bronchospastic Disease ➣ ABG (mild asthma attacks): decreased PaCO2 & respiratory alkalosis ➣ ABG (worsening airflow limitation): decreased PaO2 (from increasing ventilation-perfusion mismatch) & increased PaCO2 (fatigue w/ increased work of breathing) ➣ Chest x-ray: important in excluding other causes of respiratory failure; often normal but may have hyperinflation ➣ ECG: may have right axis deviation & ventricular irritability (beta-2 agonists, acidemia) ■ Related to therapy ➣ Beta-2 agonists: sympathetic stimulation, tachycardia, cardiac dysrhythmias ➣ Methylxanthines (eg, theophylline): cardiac dysrhythmias hematologic ■ ■ Usually normal May be associated w/ an eosinophilia ➣ Eosinophilia may parallel the degree of airway inflammation & airway hyperreactivity.

Chest discomfort frequent ■ Investigations ➣ FEV1 & maximal mid-expiratory flow rate reflect the severity of the expiratory airflow obstruction. ➣ Pts often present to hospital w/ FEV1 <35% of normal, or maximal mid-expiratory flow rate <20% of normal. When FEV1 returns to about 50%, symptoms decrease markedly. ➣ Flow-volume loop: downward scooping of the expiratory limb of the loop ➣ Between asthma attacks, FRC may be increased by 1–2 L, but TLC remains normal. ➣ DLCO usually unchanged ➣ ABG (between attacks): often normal 27 8:52 P1: SBT 0521759385p2-A 28 CUNY1088/Sladen 0 521 75938 5 May 28, 2007 Bronchospastic Disease ➣ ABG (mild asthma attacks): decreased PaCO2 & respiratory alkalosis ➣ ABG (worsening airflow limitation): decreased PaO2 (from increasing ventilation-perfusion mismatch) & increased PaCO2 (fatigue w/ increased work of breathing) ➣ Chest x-ray: important in excluding other causes of respiratory failure; often normal but may have hyperinflation ➣ ECG: may have right axis deviation & ventricular irritability (beta-2 agonists, acidemia) ■ Related to therapy ➣ Beta-2 agonists: sympathetic stimulation, tachycardia, cardiac dysrhythmias ➣ Methylxanthines (eg, theophylline): cardiac dysrhythmias hematologic ■ ■ Usually normal May be associated w/ an eosinophilia ➣ Eosinophilia may parallel the degree of airway inflammation & airway hyperreactivity.

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