Endocrine - Co-exisiting Flashcards

1
Q

Anesthesia Management for HYPERthyroid Pt: Induction

  1. Pre-oxygenate- consider? 4. Difficult a/w: MR?
    * Monitor BP/HR/adeq sedation 5. Avoid which NDMR?
  2. Good induction meds/ AVOID? * PNS- avoid bucking
  3. Intubation: type? tube? * good eye protection
    * xylocaine (IV/LTA):dec SNS stim
A
  1. hypermetabolism - increased O2 demand
  2. TPL, propofol, etomidate (may ^ BP) - AVOID Ketamine
  3. May need Nasal intubation, RAE tube
  4. Succs 1mgkg
  5. Avoid pancuronium (^HR)
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2
Q

Anesthesia Management for HYPERthyroid Pt: Positioning

  1. Thyroidectomy: Positioning/consider?
  2. Hyperthermia: MAC considerations?
  3. IV access?
A
  1. supine, arms tucked, ulnar nerve injury
  2. hyperthermia increases MAC 5%
  3. 2 IVs - extension tubing
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3
Q

Anesthesia Management for HYPERthyroid Pt: Maintenance

  1. Goal?
    * Cooling measures
  2. Hypotension: exaggerated response to?
A
  1. Avoid SNS stim

2. direct acting pressors

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4
Q

Anesthesia Management for HYPERthyroid Pt: Emergence AND Postop

  1. Thyroidecetomy: concern w/? *Postop:
  2. Damage to RLN: bilat? unilat? * thyroid storm = emerg
  3. Extubation: consider/avoid? * A/w obstruction: RLN
    4. HypoPARAthyroidism
A
  1. VC paralysis
  2. bilateral = obstruction, unilateral = hoarseness
  3. fully awake, BUT no bucking (xylocaine)
  4. hypocalcemia
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5
Q

Anesthesia Management for HYPERthyroid Pt: Preop

  1. A/w assessment - consider?
  2. Pre-meds: good/avoid?
  3. Avoid hypercarbia b/c?
  4. Avoid hypoxia b/c?
A
  1. goiter (tracheomalacia), voice quality, difficult a/w
  2. AVOID anticholinergics, GIVE anxiolytics (versed)
  3. stimulates SNS
  4. increases metab demands
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6
Q

Preop Considerations for HYPOthyroid:

  1. A/w? 5. fluid status/glucose
  2. temp intolerance? 6. impaired vent response to?
  3. increased sensitivity to? * anemia
  4. CV and metabolism? 7. cortisol for?
    8. delayed gastric emptying?
A
  1. goiter/difficult a/w
  2. cold intolerance/ vasoconstriction
  3. depressants - caution with benzos
  4. hypodynamic/unresponsive BR and slow metabolism
  5. hypovolemia/hypoglycemia
  6. hypercarbia and hypoxemia
  7. adrenal insuff
  8. reflux/RSI
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7
Q

Hypothyroidism: RA?

  • its an option
    1. Metab of LA?
A
  1. may be delayed = LA toxicity
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8
Q

HYPOthyroid: Induction

  1. Avoid?
  2. Pre-oxygenate well d/t?
  3. Induction meds: good/caution?
  4. Intubation: considerations/med?
  5. MRs: considerations?
A
  1. sedation
  2. impaired vent response to hypoxia and hypercarbia
  3. Ketamine (good), TPL (low dosing), Propofol (hypotension?)
  4. RSI, difficult a/w (goiter), succs
  5. prolonged response - use PNS, titrate
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9
Q

HYPOthyroid: Maintenance

  1. Technique? 3. Hypotension: treatment?
  2. MRs? 4. Early recognition of (3?)
    * controlled vent
    * maintain temp
A
  1. N2O alone or w/ low dose benzo’s, opioids and ketamine
  2. prolonged response
  3. Ephedrine (2.5-5.0)
  4. CHF, hypothermia, cardiac depression
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10
Q

HYPOthyroid: Emergence

  • Recovery may be delayed
    • prolonged somnolence
      1. difficult to wean ?
      2. hypothermia causes delayed?
A
  1. vent

2. MR metabolism

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11
Q

Anesthesia Management: HYPERparathyroid

  • no specific drug requirements 4. Fluids?
    1. somnolence: consideration/meds? 5. MRs: considerations?
    2. intubation: tube? 6. co-existing renal dysfxn:
    3. Positioning? Caution? - dec GFR and stones
    - avoid: VAs?
A
  1. decrease induction meds, decreased pain sensation, personalilty changes (avoid ketamine)
  2. armored RAE tube
  3. arms at side/demineralization of bones (^ fractures)
  4. avoid fluids with Ca2+, monitor UOP
  5. increased sensitivity to MRs and muscle weakness - PNS
  6. sevo & enflurane
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12
Q

Anesthetic Management: HYPOparathyroidism

  1. Induction: dosing? 5. Admin Ca2+??
  2. Intubation: tube?
  3. Positioning/Ca2+ leakage?
  4. Avoid further dec in Ca2+?
A
  1. low end dosing - lethargy and fatigue
  2. armored RAE tube
  3. arms at side/ ostetitis fibrosa cystica
  4. massive blood tx and hyperventilation
  5. 1-4gm of CaCl and CaGluconate
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13
Q

Preop Consideration for Diabetics:

  1. type of Dz?
    * meds: insulin vs orals
    * complications: renal dz, HTN, heart dz, autonomic neuropathy, infxn, peripheral neuropathy, gastroparesis
    * labs: EKG, HgbA1C, glucose (goal under 300)
A
  1. IDDM (stiff joint syndrome) or NIDDM
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14
Q

Anesthetic Considerations: Diabetes

  1. Surgical time? 5. RA = approp- concern with?
  2. Intubation: consideration? 6. aggressively treat severe brady w/?
  3. AVOID: drugs? - in pts with AN
  4. increased sensitivity to?
A
  1. early in the day
  2. potential difficult a/w, aspiration precautions, RSI
  3. nephrotoxic agents
  4. cardio-respiratory depressants
  5. autonomic neuropathy, peripheral neuropathy, hypotension
  6. epi
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