Anesthesia Considerations for African Americans Prior to Surgery

Patients encouraged to improve health-risk factors before anesthesia is needed
 
For Immediate Release
February 28, 2017
For more information
Contact: AANA Public Relations
 
Park Ridge, Illinois – African Americans suffer disproportionately with high blood pressure (HBP)  and diabetes compared with other races—health-risk factors which must be considered during the pre-anesthetic evaluation to increase the likelihood of anesthetic-surgical success, according to the American Association of Nurse Anesthetists (AANA).
 
“By taking measures against the development of high blood pressure or diabetes, or by working with their healthcare provider to successfully manage existing conditions, African Americans can positively impact their surgical and anesthetic experience,” said John Bing, a Certified Registered Nurse Anesthetist (CRNA) who serves on the AANA’s Diversity Task Force.
 
According to the 2015 U.S. Census Bureau, 13.3 percent of the U.S. population is African American. An individual’s response to anesthesia may vary among different populations due to age, gender, genetics, comorbidities, and cultural and environmental factors.
 
High Blood Pressure
For African Americans, HBP often develops early in life and can be severe. More than 40 percent of African American men and women have HBP, making the prevalence of HBP in African Americans among the highest in the world.
 
Theories as to why so many African Americans have high blood pressure suggest a connection to higher rates of obesity and diabetes among African Americans. Researchers have also found that some African Americans may be genetically predisposed to a higher sensitivity to salt. Salt sensitivity is prevalent in 73 percent of all African American HBP patients
 
“Communication between African American patients and their anesthesia professionals is essential to the anesthesia process,” said AANA President Cheryl Nimmo, DNP, MSHSA, CRNA. “Before surgery, the preanesthesia interview provides a valuable opportunity for the patient to provide important information that will help determine the safest, most effective care plan possible. It is equally important for the patient to communicate with their anesthesia professional after surgery.”
 
Diabetes
Compared to the general population, African Americans are disproportionately affected by diabetes: 13.2 percent of all African Americans who are 20 years or older have diagnosed diabetes.
 
Being African American doesn't guarantee that a person will develop diabetes. However, African Americans, as well as most minority ethnic groups, do have an unusually high risk. In addition to ethnicity, some of the more well-established risk factors include:
  • High blood pressure
  • Sedentary, inactive lifestyles
  • Low HDL cholesterol ("good" cholesterol) and/or high triglycerides
  • Obesity
  • Family history of diabetes
  • Age 45 or older
  • Prediabetes (higher-than-normal glucose levels, but not yet full-blown diabetes)
  • A history of gestational diabetes or having a baby with a birth weight of 9 pounds or more.
“Many factors go into determining the best anesthetic and administration technique for each patient,” said Bing. “Pregnancy, age, or hereditary disorders such as sickle cell anemia require special consideration and can influence the anesthesia selection process.”
 
Modifiable Versus Nonmodifiable Risk Factors
Modifiable risk factors are health factors that can be changed – such as weight, diet, and activity level. Nonmodifiable risk factors are health influences that cannot be changed, such as age, family history, and ethnicity. While an individual should not allow their nonmodifiable risk factors to define them, it's important to identify these elements so improved health can become the focus of the patient. CRNAs take a patient-centered approach to anesthesia delivery; therefore, engaging in a dialogue about health status encourages a collaborative environment and supports patient optimization and safety.