Anesthesia in High-Risk Patients

341 Pages·2018·5.394 MB·English

by  Jean-Luc Fellahi, Marc Leone (eds.)

Jean-Luc Fellahi
Marc Leone Editors
Anesthesia in
High-Risk Patients
123
Anesthesia in High-Risk Patients
Jean-Luc Fellahi • Marc Leone
Editors
Anesthesia in High-Risk
Patients
Editors
Jean-Luc Fellahi Marc Leone
Department of Anaesthesiology and Service d'Anesthésie-Réanimation
Critical Care Medicine Hôpital Nord
Louis Pradel Hosp, Hospices Civils Lyon Marseille cedex 20
Lyon, Rhône France
France
ISBN 978-3-319-60803-7 ISBN 978-3-319-60804-4 (eBook)
https://doi.org/10.1007/978-3-319-60804-4
Library of Congress Control Number: 2017954493
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Foreword
The practice of anaesthesiology (which in the definition of the European Society of
Anaesthesiology includes anaesthesia, intensive care and perioperative medicine as
well as pain therapy) has profoundly changed since the year 2000. Anaesthesiologists
are not only those specialists who are in charge of providing analgesia and comfort
to those patients who undergo surgery or invasive procedures. Anaesthesiologists
are now those specialists who manage patients with comorbidities so that postop-
erative morbidity and mortality is as low as possible.
A recent European study [1] has revealed that postoperative mortality is
slightly below 4%, orders of magnitude higher than the previously documented
mortality associated with the practice of anaesthesia. It seems clear from this
data that the practice of anaesthesiology has become the practice of perioperative
medicine with new challenges: taking the patients and their comorbidities
through the perioperative period so the intervention does not worsen the natural
history of their comorbidities. In this context, the recent European Guidelines
underline the role that anaesthesiologists play in decreasing postoperative mor-
bidity and mortality [2, 3].
If the decrease of perioperative morbidity and mortality is the focus of anaes-
thesiologists, it becomes clear that identifying and managing the patient-related
risk factors and their interaction with the intervention-related risk is mandatory.
The group of experts who contributed to this book has reviewed many of the
patient-related risk factors that are relevant for the contemporary practice of peri-
operative medicine. Some of the risks are frequent (atheroma and coronary artery
disease); other risks have a lower incidence (e.g. pulmonary hypertension). Some
“new” risk factors (frailty, drug addiction, severe obesity) are also discussed and
their novelty reflects the recent social changes with consequences on the medical
practice.
Each chapter provides anaesthesiologists with the necessary synthesis of data
thus allowing them to manage risk factors in individual patients. The chapters are
rich with the most recent publications and evidence, and the authors and the
Editor should be commended for their efforts. The book, by gathering dispersed
information, will facilitate the necessary integration of information and decision
v
vi Foreword
making. This book arrives at a time when clinicians value the concentration of
valuable information.
Dan Longrois
Département d’Anesthésie-Réanimation
Hôpital Bichat
Paris, France
References
1. Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, Vallet B, Vincent JL, Hoeft A,
Rhodes A: Mortality after surgery in Europe: a 7 day cohort study. Lancet. 2012; 380:
1059–65.
2. Kristensen SD, Knuuti J, Saraste A, Anker S, Botker HE, De Hert S, Ford I, Gonzalez J, Jr.,
Gorenek B, Heyndrickx GR, Hoeft A, Huber K, Iung B, Kjeldsen KP, Longrois D, Luescher
TF, Pierard L, Pocock S, Price S, Roffi M, Sirnes PA, Uva MS, Voudris V, Funck-Brentano C:
2014 ESC/ESA Guidelines on non- cardiac surgery: cardiovascular assessment and manage-
ment: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and manage-
ment of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology
(ESA). Eur J Anaesthesiol. 2014;31:517–73.
3. Longrois D, Hoeft A, De Hert S: 2014 European Society of Cardiology/European Society of
Anaesthesiology guidelines on non-cardiac surgery: cardiovascular assessment and manage-
ment: A short explanatory statement from the European Society of Anaesthesiology members
who participated in the European Task Force. Eur J Anaesthesiol. 2014;31:513–6.
Contents
Part I Cardiac and Hemodynamic Risks
1 The Patient with Acute Coronary Syndrome ..................... 3
Simon Hennink-Schadenberg and Benedikt Preckel
2 The Patient with Advanced Chronic Heart Failure ................ 19
Patrick F. Wouters and Koen Lapage
3 Pulmonary Hypertension in Cardiac Surgery .................... 39
Bastien Olivier
4 The Patient with Severe Aortic Valve Stenosis .................... 49
Priscilla de Medeiros Teixeira, Rémi Schweizer,
and Jean-Luc Fellahi
5 The Patient with Congenital Cardiac Disease .................... 61
Philippe Mauriat and Jana Assy
6 Perioperative Management of the Patient with an Implantable
Cardioverter Defibrillator .................................... 77
Julien Amour
7 What Every Anaesthetist Needs to Know About Respiratory
and Cardiovascular Dynamics in Patients with Obesity or
Intra-abdominal Hypertension ................................ 91
Manu LNG Malbrain, Claudia Olvera, and Adrian Regli
Part II Respiratory Risks
8 Obstructive Sleep Apnea (OSA) and Anesthesia .................. 119
Silvia Martin and César Aldecoa
9 Anesthesia for End-Stage Respiratory Disease ................... 139
Morgan Le Guen and Sofian Faiz
vii
viii Contents
Part III Renal and Metabolic Risks
10 The Patient with End-Stage Renal Disease ....................... 153
Antoine Dewitte and Olivier Joannès-Boyau
11 The Patient with End-Stage Liver Disease ....................... 165
Emmanuel Weiss and Catherine Paugam-Burtz
12 The Severely Obese Patient ................................... 183
Lorrie Tremblay, Jean S. Bussières, and Paul Poirier
13 Anaesthesia and Rare Metabolic Disorders ...................... 201
Markus M. Luedi and Frank Stueber
Part IV Neurological Risks
14 Patients with Cerebral Diseases ................................ 213
C. Binet and A.C. Lukaszewicz
15 Patients with Chronic Neuromuscular Diseases. . . . . . . . . . . . . . . . . . . 227
Valentine Léopold, Alice Blet, Kathleen McGee, and Benoît Plaud
Part V Other Risks
16 The Patient with Septic Shock ................................. 241
Bruno Pastene, Gary Duclos, and Marc Leone
17 The Patient with Haemorrhagic Risk ........................... 255
Claire Pailleret Ringuier and Charles-Marc Samama
18 The Transplanted Patients: Can We Improve Outcomes
of Non-transplant Surgery? ................................... 271
Christopher P. R. Walker, Paul Harris, Janos Fazakas, Janos Gal,
and Nandor Marczin
19 Aged Patients with a Frailty Syndrome ......................... 285
Claudia Spies, Rudolf Mörgeli, Alissa Wolf, Anika Müller,
and Oliver Birkelbach
20 The Allergic Patient ......................................... 303
Paul Michel Mertes and Charles Tacquard
21 The Addicted Patient ........................................ 317
Pierre Beaulieu
22 The Jehovah’s Witness Patient. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
Chantal Lerminiaux and Philippe Van der Linden
Part I
Cardiac and Hemodynamic Risks
The Patient with Acute Coronary 1
Syndrome
Simon Hennink-Schadenberg and Benedikt Preckel
A growing number of patients with coronary artery diseases are subjected to sur-
gery. Anaesthesia care providers will face patients with former or recent ACS. An
ACS might also occur for the very first time during surgery or during the postopera-
tive period. This chapter will highlight the relevant physiology and perioperative
treatment options in this patient population.
Acute coronary syndrome (ACS) resembles different manifestations of coronary
artery disease: unstable angina pectoris (UAP), non-ST-elevation myocardial infarction
(non-STEMI) and ST-elevation myocardial infarction (STEMI; see Table 1.1) [1].
A differentiation is made on electrocardiogram (ECG) changes (STEMI versus
non-STEMI/UAP) and release of cardiac-specific biomarkers (non-STEMI versus
UAP). Constantly improvements of detection of very low concentrations of cardiac-
specific biomarkers like troponin T or I, along with improved imaging techniques,
nowadays allow detection of myocardial tissue necrosis also in the absence of
Table 1.1 Classification of acute coronary syndrome [2]
STEMI ST segment elevation ≥2 leads or new LBBB on 12-lead ECG and release of
cardiac-specific biomarkers
NSTEMI ST depression, non-specific ST segment abnormalities, sometimes even normal
ECG and release of cardiac-specific biomarkers
UAP ST depression, non-specific ST segment abnormalities, sometimes even normal
ECG without release of cardiac-specific biomarkers
ECG electrocardiogram, LBBB left bundle branch block
S.Hennink-Schadenberg,M.D.,M.Sc.•B.Preckel,M.D.,Ph.D.,D.E.A.A.(*)
Department of Anaesthesiology, Academic Medical Center, University of Amsterdam,
Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
e-mail: [email protected]; [email protected]
© Springer International Publishing AG 2018 3
J.-L. Fellahi, M. Leone (eds.), Anesthesia in High-Risk Patients,
https://doi.org/10.1007/978-3-319-60804-4_1