Cindy Yeoh received her Medical Degree from Washington University School of Medicine in St. Louis, USA. She completed 4 years of General Surgery residency before entering a residency in Anesthesiology at St. Vincent’s Hospital/New York Medical College, USA. She currently practices at Memorial Sloan Kettering Cancer Center in New York. She is part of the Quality Assurance Committee and chairs the RISQ committee (Reporting to Improve Safety and Quality).
Abstract
Causes of hyperhomocysteinemia include genetic predisposition, acquired deficiencies (folate, B6, B12), malignancies, and renal disease. Elevated homocysteine levels result in thromboembolic complications by causing endothelial dysfunction, increasing procoagulant activity, and decreasing antithrombotic effect. Challenges of patients with hyperhomocysteinemia undergoing anesthesia are related mainly to the procoagulant state and efforts should be focused on thromboprophylaxis and maintenance of hemodynamics and euvolemia. Nitrous oxide should be avoided as it inhibits methionine synthase and can further increase homocysteine levels. Patients with co-morbidities that include coronary artery disease, peripheral vascular disease, and cerebrovascular disease are at increased risk for peri-operative thrombotic events. This risk is amplified for high-risk procedures under general anesthesia.
