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RUSVM Anesthesiology 2016 > Anesthesia for Endocrine Disease > Flashcards

Anesthesia for Endocrine Disease Flashcards

1
Q

Diabetes Mellitus

A

Insulin deficiency or decreased sensitivity to insulin

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2
Q

What are the clinical signs of Diabetes Mellitus?

A

PU/PD
Polyphagia with weight loss
Cataracts in Dogs

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3
Q

What are the clinical pathology findings of Diabetes Mellitus?

A

Hyperglycemia
glucosuria
Increased ALP

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4
Q

When should Diabetes Mellitus animals be anesthetized?

A

Only when correcting a life-threatening condtion

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5
Q

What is required before emergency anesthesia with Diabetes Mellitus?

A

Aggressive fluid therapy
Insulin therapy
Dextrose
Potassium supplementation

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6
Q

What is included in pre-op for Diabetes Mellitus?

A 
CBC 
Chemistry with electrolytes
Routine overnight fast 
give 1/2 normal AM insulin dose
Check Blood Glucose before induction
Treat hypoglycemia as needed
Verify normoglycemia before administering drugs
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7
Q

What drugs should you avoid with Diabetes Mellitus?

A

Alpha 2 agonists

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8
Q

What can cause hyperglycemia?

A

Alpha 2 agonists

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9
Q

How do alpha 2 agonists cause hyperglycemia?

A

inhibition of insulin release or stimulation of glucagon release

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10
Q

How often do you check Blood Glucone with Diabetes Mellitus during anesthesia?

A

every 30-60 mins

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11
Q

What is the level of blood glucose maintained during anesthesia?

A

150-250mg/dL

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12
Q

What do you do to treat low Blood glucose during anesthesia?

A

1-5% dextrose in balanced electrolyte solution

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13
Q

What do you do post-op for a patient with Diabetes Mellitus?

A

Continue monitoring Blood Glucose every 1-2 hours until the patient is eating
Return to normal feeding schedule ASAP
Adjust insulin dose if anorexic

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14
Q

Insulinoma

A

Insulin-secreting tumor of pancreatic beta cells

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15
Q

What age dogs are insulinomas common?

A

9-10 year olds

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16
Q

What drugs do you administer to stabilize an insulinoma before surgery?

A

Glucocorticoids

Diazoxide

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17
Q

What should you do while the patient is under anesthesia for an insulinoma?

A

Monitor BG
Supplement Dextrose
Add glucocorticoids if necessary
Consider glucagon if unable to maintain with dextrose and glucocorticoids

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18
Q

What level should you keep BG at for an animal with an insulinoma under anesthesia?

A

greater than 50mg/dL

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19
Q

What are the two types of Diabetes Insipidus?

A

Central

Nephrogenic

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20
Q

What is Central DI?

A

ADH deficiency

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21
Q

What is Nephrogenic DI?

A

Renal insensitivity to ADH

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22
Q

What are the clinical signs of DI?

A

PU/PD

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23
Q

How do you treat Central DI?

A

Desmopressin

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24
Q

What should you NEVER do with Diabetes Insipidus fdor anesthesia?

A

Restrict water

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25
Q

What should you check in a patient with Diabetes Insipidus before induction?

A

Na levels

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26
Q

What level should Sodium be maintained at?

A

160mg/dL

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27
Q

What fluids should you use for Diabetes Insipidus under anesthesia?

A

hypotonic fluids
5% dextrose in water
.45% NaCl + 2.5% Dextrose

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28
Q

What is a common finding in animals with Hypothyroidism?

A

Bradycardia
Hypothermia
Hypoventilation

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29
Q

What is a common finding in cats with hyperthyroidism?

A

Thickened myocardium - thyrotoxic cardiomyopathy
murmur or a gallop
hypertension
tachyarrythmias

30
Q

What do you do for pre-op in an animal with hyperthyroidism?

A

Minimize stress

31
Q

What is possible to happen with hyperthyroidism under anesthesia?

A

“thyroid storm”

32
Q

Thyroid Storm

A

Catecholamine release
increased HR, BP
arrhythmias
hyperthermia

33
Q

What drugs should you avoid with hyperthyroidism under anesthesia?

A

Avoid drugs that increase HR, myocardial work, and oxygen consumption: Ketamine, Routine anticholinergics
Avoid drugs that result in significant CV changes: Acepromazine and Alpha 2 agonists
Avoid mask or chamber induction

34
Q

What should you monitor for in a hyperthyroid patient under anesthesia?

A

HR
BP
Avoid tachycardia

35
Q

What drug can be used with a patient with hyperthyroidism for Bp support?

A

Dopamine

36
Q

Hyperparathyroidism

A

Excess production of PTH causing hypercalcemia

37
Q

What is indicated in patients with hyperparathyroidism?

A

Surgery to remove the tumor

38
Q

What should you do before anesthesia in a patient with hyperparathyroidism?

A

decrease serum iCa

39
Q

What do you use to decrease serum iCa in a patient with hyperparathyroidism?

A

Fluid therapy with .9% NaCl
Diuretics
Steroids

40
Q

What does marked chronic hypercalcemia cause?

A

ventricular arrhythmias

41
Q

What drugs do you want to avoid in a patient with hyperparathyroidism?

A

Avoid long acting drugs or those that cause significant CV effects

42
Q

What frequently occurs after surgery with an animal with hyperparathyroidism?

A

Hypocalcemia

43
Q

How do you treat the hypocalcemia that results from surgery in a patient with hyperparathyroidism?

A

Ca gluconate

PO calcium

44
Q

Hypoadrenocorticism

A

Decreased glucocorticoid and mineralocorticoid production by the adrenal glands

45
Q

What is Atypical Addison’s?

A

decreased glucocorticoids only

46
Q

What results from Hypoadrenocorticism?

A 
Hypoglycemia
Hyperkalemia
Hyponatremia
hypovolemia
increased BUN
47
Q

Addisonian Crisis

A

Hypoglycemia
hyperkalemia
Hyponatremia
hypovolemic shock

48
Q

What should be done pre-op for Hypoadrenocorticism?

A

Recent bloodwork for electrolytes and blood glucose
continue administering scheduled PO gluco- or mineralocorticoids the morning of surgery
Consider administering a physiologic dose steroid IV at the time of induction

49
Q

What drug should be avoid in patients with hypoadrenocorticism?

A

etomidate

50
Q

What should you treat and monitor in a patient with hypoadrenocorticism?

A

Hypoglycemia

electrolyte abnormalities

51
Q

What do you do Post-op for a patient with hypoadrenocorticism?

A

Restart chronic PO steroid ASAP
Monitor for signs of adrenal insufficiency
Recheck BG, electrolytes as needed

52
Q

Hyperadrenocorticism

A

Excessive adrenal hormones

53
Q

What are the two types of hyperadrenocorticism?

A

Pituitary dependent

Non pituitary dependent

54
Q

What are the clinical issues associated with hyperadrenocorticism?

A

Hypertension
Hypercoagulability Hepatomegaly
Poor Immune function and wound healing

55
Q

What are animals with hyperadrenocorticism susceptible to?

A

Pulmonary thromboembolism or thrombosis at other sites

56
Q

Pre-op for Hyperadrenocorticism

A

Serum Chemistry and CBC

Baseline blood pressure

57
Q

What should you monitor in an animal with hyperadrenocorticism?

A

arterial blood pressure

Monitor for PTE

58
Q

What is a sign for Pulmonary Thromboembolism (PTE)?

A

Sharp drop in EtCO2

59
Q

What do patients undergoing adrenal-suppressive therapy develop post-op?

A

adrenal insufficiency due to stress

60
Q

How would you treat a patient with adrenal insufficiency due to stress associated with Hyperadrenocorticim?

A

Low-dose steroid treatment

61
Q

Pheochromocytoma

A

tumor of the adrenal medulla producing epinephrine and norepinephrine

62
Q

What is a clinical finding in patients with Pheochromocytoma?

A

Tachyarrythmias

Hypertension

63
Q

Why is the surgery difficult for Pheochromocytoma?

A

high vascularity

potential for catecholamine release secondary to tumor handling

64
Q

Pre-op for Pheochromocytoma

A

Stabilize BP and HR

65
Q

What drug do you use to stabilize BP and HR in a patient with Pheochromocytoma?

A

phenoxybenzamine

66
Q

What drugs do you use to control HR in a patient with Pheochromocytoma?

A

Beta Blockers

67
Q

What drugs should you avoid in patients with Pheochromocytoma?

A

Drugs that cause tachycardia or vasoconstriction: Ketamine, Alpha 2 agonists, or Pre-anesthetic atropine

68
Q

What do you monitor in a patient with Pheochromocytoma?

A

HR and BP

69
Q

What do you use for tachyarrythymias in animals with Pheochromocytoma?

A

Beta Blockers

70
Q

What can occur upon removal of Pheochromocytoma?

A

acute drop in catecholamines causing hypotension and cradycadia

71
Q

How would you treat a drop in catecholamines?

A

Dobutamine
ephedrine
phenylephrine

72
Q

Post-op for Pheochromocytoma

A

Hospitalize for at least 48 hours
Monitor ECG and BP
Monitor BG

RUSVM Anesthesiology 2016 (38 decks)

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