An acquired clinical syndrome of severe disabling
fatigue of at least 6 months' duration that affects both physical and mental
functioning and is present at least 50% of the time.
Myalgic Encephalitis; Postviral Fatigue Syndrome;
Chronic Fatigue Immune Dysfunction Syndrome; Postural Orthostatic
Estimates range from 3-25:10,000 in the general
population. Seems to be more common in females and in Caucasians.
No evidence of a genetic basis.
Results of investigations are inconclusive.
Suggested theories include impaired hypothalamic-pituitary-adrenal
interactions and abnormalities of the central and peripheral nervous
systems. Another hypothesis is based on impaired inflammatory cytokine
production and cellular immunity, which may be linked to the symptoms of
chronic fatigue syndrome (CFS) through changes in neurovascular regulation.
Is based on clinical findings and requires the exclusion of
other medical and psychiatric disorders, such as endocrinopathies
(hypothyroidism, Addison disease),
sleep apnea, narcolepsy, severe obesity,
major depressive disorder, bipolar affective disorder, schizophrenia,
chronic mononucleosis, malignancy, autoimmune disease, subacute infection,
alcohol or substance abuse, or reactions to medications. To fulfill the
Centers for Disease Control and Prevention (CDC) diagnostic criteria for
CFS, a patient must satisfy two criteria. First, the patient must have
chronic fatigue for a minimum of 6 months with other medical conditions
excluded. Second, the patient must concurrently have four or more of the
following: (1) substantial impairment of short-term memory or concentration,
(2) sore throat, (3) tender lymph nodes, (4) muscle pain, (5) multijoint
pain without swelling or tenderness, (6) headaches of a new type, pattern,
or severity, (7) unrefreshing sleep, and (8) postexertional malaise lasting
more than 6 hours. Symptoms must have persisted or recurred during 6 or more
consecutive months of illness and must not have predated the fatigue.
As above. Remissions and relapses characterize
the clinical course. Orthostatic hypotension consistent with postural
orthostatic tachycardia syndrome is described in adolescents with this
No specific tests are required. The
principal anesthetic concern is that the condition has not been misdiagnosed
and an unrecognized condition is present (e.g., hypothyroidism).
Multiple anecdotal reports of
exaggerated response to sedative hypnotics and anesthesia inducing agents
exist. However, no systematic study of any anesthetic agents or techniques
has been performed.
Concomitant therapy may include
corticosteroids which may require perioperative supplementation.
De Lorenzo F, Hargreaves J, Kakkar VV: Pathogenesis and management of
delayed orthostatic hypotension in patients with chronic fatigue syndrome.
Clin Auton Res 7:185, 1997.
Fukuda K, Straus SE, Hickie I, et al: The chronic fatigue syndrome: A
comprehensive approach to its definition and study. International Chronic
Fatigue Syndrome Study Group. Ann Intern Med
Steele L, Dobbins JG, Fukuda K, et al: The epidemiology of chronic fatigue in
San Francisco. Am J Med 105:83S, 1998.