Anesthesia for Endocrine Disease

Question 1

Diabetes Mellitus

Answer 1

Insulin deficiency or decreased sensitivity to insulin

Question 2

What are the clinical signs of Diabetes Mellitus?

Answer 2

PU/PD
Polyphagia with weight loss
Cataracts in Dogs

Question 3

What are the clinical pathology findings of Diabetes Mellitus?

Answer 3

Hyperglycemia
glucosuria
Increased ALP

Question 4

When should Diabetes Mellitus animals be anesthetized?

Answer 4

Only when correcting a life-threatening condtion

Question 5

What is required before emergency anesthesia with Diabetes Mellitus?

Answer 5

Aggressive fluid therapy
Insulin therapy
Dextrose
Potassium supplementation

Question 6

What is included in pre-op for Diabetes Mellitus?

Answer 6

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

Question 7

What drugs should you avoid with Diabetes Mellitus?

Answer 7

Alpha 2 agonists

Question 8

What can cause hyperglycemia?

Answer 8

Alpha 2 agonists

Question 9

How do alpha 2 agonists cause hyperglycemia?

Answer 9

inhibition of insulin release or stimulation of glucagon release

Question 10

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

Answer 10

every 30-60 mins

Question 11

What is the level of blood glucose maintained during anesthesia?

Answer 11

150-250mg/dL

Question 12

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

Answer 12

1-5% dextrose in balanced electrolyte solution

Question 13

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

Answer 13

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

Question 14

Insulinoma

Answer 14

Insulin-secreting tumor of pancreatic beta cells

Question 15

What age dogs are insulinomas common?

Answer 15

9-10 year olds

Question 16

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

Answer 16

Glucocorticoids

Diazoxide

Question 17

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

Answer 17

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

Question 18

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

Answer 18

greater than 50mg/dL

Question 19

What are the two types of Diabetes Insipidus?

Answer 19

Central

Nephrogenic

Question 20

What is Central DI?

Answer 20

ADH deficiency

Question 21

What is Nephrogenic DI?

Answer 21

Renal insensitivity to ADH

Question 22

What are the clinical signs of DI?

Answer 22

PU/PD

Question 23

How do you treat Central DI?

Answer 23

Desmopressin

Question 24

What should you NEVER do with Diabetes Insipidus fdor anesthesia?

Answer 24

Restrict water

Question 25

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

Answer 25

Na levels

Question 26

What level should Sodium be maintained at?

Answer 26

160mg/dL

Question 27

What fluids should you use for Diabetes Insipidus under anesthesia?

Answer 27

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

Question 28

What is a common finding in animals with Hypothyroidism?

Answer 28

Bradycardia Hypothermia Hypoventilation

Question 29

What is a common finding in cats with hyperthyroidism?

Answer 29

Thickened myocardium - thyrotoxic cardiomyopathy murmur or a gallop hypertension tachyarrythmias

Question 30

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

Answer 30

Minimize stress

Question 31

What is possible to happen with hyperthyroidism under anesthesia?

Answer 31

"thyroid storm"

Question 32

Thyroid Storm

Answer 32

Catecholamine release increased HR, BP arrhythmias hyperthermia

Question 33

What drugs should you avoid with hyperthyroidism under anesthesia?

Answer 33

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

Question 34

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

Answer 34

HR BP Avoid tachycardia

Question 35

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

Answer 35

Dopamine

Question 36

Hyperparathyroidism

Answer 36

Excess production of PTH causing hypercalcemia

Question 37

What is indicated in patients with hyperparathyroidism?

Answer 37

Surgery to remove the tumor

Question 38

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

Answer 38

decrease serum iCa

Question 39

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

Answer 39

Fluid therapy with .9% NaCl Diuretics Steroids

Question 40

What does marked chronic hypercalcemia cause?

Answer 40

ventricular arrhythmias

Question 41

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

Answer 41

Avoid long acting drugs or those that cause significant CV effects

Question 42

What frequently occurs after surgery with an animal with hyperparathyroidism?

Answer 42

Hypocalcemia

Question 43

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

Answer 43

Ca gluconate | PO calcium

Question 44

Hypoadrenocorticism

Answer 44

Decreased glucocorticoid and mineralocorticoid production by the adrenal glands

Question 45

What is Atypical Addison's?

Answer 45

decreased glucocorticoids only

Question 46

What results from Hypoadrenocorticism?

Answer 46

``` Hypoglycemia Hyperkalemia Hyponatremia hypovolemia increased BUN ```

Question 47

Addisonian Crisis

Answer 47

Hypoglycemia hyperkalemia Hyponatremia hypovolemic shock

Question 48

What should be done pre-op for Hypoadrenocorticism?

Answer 48

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

Question 49

What drug should be avoid in patients with hypoadrenocorticism?

Answer 49

etomidate

Question 50

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

Answer 50

Hypoglycemia | electrolyte abnormalities

Question 51

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

Answer 51

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

Question 52

Hyperadrenocorticism

Answer 52

Excessive adrenal hormones

Question 53

What are the two types of hyperadrenocorticism?

Answer 53

Pituitary dependent | Non pituitary dependent

Question 54

What are the clinical issues associated with hyperadrenocorticism?

Answer 54

Hypertension Hypercoagulability Hepatomegaly Poor Immune function and wound healing

Question 55

What are animals with hyperadrenocorticism susceptible to?

Answer 55

Pulmonary thromboembolism or thrombosis at other sites

Question 56

Pre-op for Hyperadrenocorticism

Answer 56

Serum Chemistry and CBC | Baseline blood pressure

Question 57

What should you monitor in an animal with hyperadrenocorticism?

Answer 57

arterial blood pressure | Monitor for PTE

Question 58

What is a sign for Pulmonary Thromboembolism (PTE)?

Answer 58

Sharp drop in EtCO2

Question 59

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

Answer 59

adrenal insufficiency due to stress

Question 60

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

Answer 60

Low-dose steroid treatment

Question 61

Pheochromocytoma

Answer 61

tumor of the adrenal medulla producing epinephrine and norepinephrine

Question 62

What is a clinical finding in patients with Pheochromocytoma?

Answer 62

Tachyarrythmias | Hypertension

Question 63

Why is the surgery difficult for Pheochromocytoma?

Answer 63

high vascularity | potential for catecholamine release secondary to tumor handling

Question 64

Pre-op for Pheochromocytoma

Answer 64

Stabilize BP and HR

Question 65

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

Answer 65

phenoxybenzamine

Question 66

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

Answer 66

Beta Blockers

Question 67

What drugs should you avoid in patients with Pheochromocytoma?

Answer 67

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

Question 68

What do you monitor in a patient with Pheochromocytoma?

Answer 68

HR and BP

Question 69

What do you use for tachyarrythymias in animals with Pheochromocytoma?

Answer 69

Beta Blockers

Question 70

What can occur upon removal of Pheochromocytoma?

Answer 70

acute drop in catecholamines causing hypotension and cradycadia

Question 71

How would you treat a drop in catecholamines?

Answer 71

Dobutamine ephedrine phenylephrine

Question 72

Post-op for Pheochromocytoma

Answer 72

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