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Anesthesia in High-Risk Surgical Patients with Uncommon Disease

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The High-risk Surgical Patient

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Abstract

Providing anesthesia to a high-risk surgical patient presents many challenges to the anesthesiologist during the peri-operative period. When you add an uncommon disease into the equation, these challenges are only magnified. It would be impractical and impossible to know about every possible disease state. Rather, it is the responsibility of the anesthesiologist to have a thorough understanding of how end organ disease of each organ system may impact the intra-operative anesthetic and how end organ disease of a specific organ system may impact the physiology and function for other organ systems. When providing anesthesia for a high-risk surgical patient who also has an uncommon disease, the key is to approach these patients commonly. This begins with a thorough pre-operative history and physical exam focusing on what makes this case high risk (i.e., the surgery versus the patient’s co-morbidities versus a combination of both), the patient’s functional status, and any end organ dysfunction that patient has at baseline. Next, one must consider how the anatomic manipulation of the surgical procedure is going to alter the patient’s physiology. These will help guide the anesthesiologist’s choice of monitoring modalities and help to prepare for and anticipate any possible hemodynamic derangements during the case. If it is discovered that the patient has an uncommon disease, the anesthesiologist should take the time to quickly look up the highlights of the disease and what end organs are impacted by this process and if there are any special anesthetic implications. In this chapter, we will highlight some of the “more common” uncommon disease states and discuss the anesthetic implications.

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Change history

  • 25 April 2023

    A correction has been published.

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Authors and Affiliations

  1. Department of Anesthesiology & Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Andrew K. Gold, Tal Mandelbaum & Lee A. Fleisher

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  1. Andrew K. Gold
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  2. Tal Mandelbaum
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  3. Lee A. Fleisher
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Editors and Affiliations

  1. Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Paolo Aseni

  2. Divisione di Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo, Pavia, Pavia, Italy

    Antonino Massimiliano Grande

  3. Div. of Emerg. Surg., Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland

    Ari Leppäniemi

  4. Department of Pathophysiology and Transplantation, General Surgery and Trauma Team, University of Milano, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Osvaldo Chiara

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Gold, A.K., Mandelbaum, T., Fleisher, L.A. (2023). Anesthesia in High-Risk Surgical Patients with Uncommon Disease. In: Aseni, P., Grande, A.M., Leppäniemi, A., Chiara, O. (eds) The High-risk Surgical Patient. Springer, Cham. https://doi.org/10.1007/978-3-031-17273-1_28

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