Chronic Fatigue Syndrome

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 Tachycardia Syndrome.

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 condition.

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.