Anesthesia for Endocrine Disorders Flashcards by Kate Guiremand

what is required before emergency anesthesia of a DKA patient

agressive fluid replacement

regular insulin therapy

dextrose and potassium supplementation

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T/F DM patients should be scheduled first thing in the morning and not fasted prior to anesthesia

False

they should be scheduled first thing, but they need to be fasted for 8-12 hours and given 1/2 normal insulin dose

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what should be checked before induction of a DM patient

blood glucose

treat hypoglycemia as needed - verify normoglycemia before administering anesthetic drugs

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which class of drug should be avoided in DM patients

alpha 2 agonists

can cause hyperglycemia via inhibition of insulin release or stimulation of glucagon release

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what drug protocol should be used for DM patients

short-acting drugs or those that can be reversed

goal is to resume normal feeding and insulin schedule ASAP

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how often should blood glucose be check while under anesthesia

q 30-60 min (depends on initial values)

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blood glucose should be maintained between ___________mg/dl

150-250 mg/dl

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what fluids should be used in DM patients

1-5% dextrose in balanced electrolyte solution as needed (NOT D5W)

have 2 bags prepaired - one with dextrose and one without (used for bolus)

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How often should BG be check post op in DM patients

q 1-2 hours until patient is eating

continue fluids with dextrose PRN

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why do you not want to over supplement dextrose in insulinoma patients

high blood glucose stimulates insulin release from the tumor

patients are adapted to low BG

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where should you keep blood glucose in insulinoma patients

>50 mg/dl

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T/F adding glucocorticoids may be necessary to maintain BG in insulinoma patients

True

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what should you consider giving if you are unable to maintain BG with dextrose and glucocorticoids in insulinoma patients

glucagon

promotes gluconeogenesis and glycogenolysis

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what drugs are contraindicated in insulinoma patients

none - no specific contraindications

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what should be monitored before induction and q 1 hour if abnormal in DI patients

maintain <160 mEq/L

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what happens if Na is increased/decreased faster than 0.5 mEq/L/hour

may cause fatal brain damage (central pontine myelinolysis)

DO NOT DO THIS…..EVER!

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__________ fluids should be used as necessary in DI patients

hypotonic

5% dextrose in water (D5W)*
0.45% NaCl + 2.5% dextrose*

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bradycardia, hypothermia, and hypoventilation are more likely in which patients

hypothyroid

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drug protocol for hypothyroid animals

conservative doses

reversible drugs

no specific contraindications

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why might hyperthyroid animals have a murmur and/or gallop on auscultation

thickened myocardium - thyrotoxic cardiomyopathy

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what is possible in hyperthyroid cats that causes an increase in HR, BP, arrhythmias, and hyperthermia

“Thyroid storm” - catecholamine release

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how should hyperthyroid animals be treated pre-op

stabilized before elective procedures

minimize stress

Tx of hyperT may unmask renal disease

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why should ketamine and routine anticholinergics be avoided in hyperT patients

increase HR, myocardial work, and O2 consumption

anticholinergics should NOT be withheld in bradycardic patients

which drugs can cause significant CV changes and should be avoided in hyperT patients

acepromazine

alpha 2 agonists

why should mask/chamber induction be avoided in hyperT patients

high stress

what can be used to manage HR in hyperT patients

opioids and benzodiazepines

if a hyperT patient is normally hypertensive or has renal compromise, MAP should be kept at \_\_\_\_\_\_\_\_

\>70 mmHg ## Footnote *kidneys used to higher MAP and are less able to compensate for anesthesia induced hypotension (impaired autoregulation)*

what can be used for BP support in hyperT patients

dopamine

what should be decreased before anesthesia in hyperPTH patients

**serum iCa** *Fluid therapy with 0.9% NaCl, Diuretics, Steroids*

marked, chronic hyperCa can lead to \_\_\_\_\_\_\_\_

ventricular arrhythmias ## Footnote *rapid development of V fib possible at the time of induction*

what drugs should be avoided in hyperPTH

long-acting significant CV effects

what frequently happens post-op with hyperPTH patients

**hypoCa** *monitor in hospital, Tx with Ca gluconate and PO calcium PRN*

how recent should bloodwork be preformed in addisonian patients

\<24 hours pre-op ## Footnote *primary concern = BG and lytes*

T/F PO gluco- or mineralocorticoids should be discontinued the morning of Sx

**False** *continue administering scheduled PO gluco- or minalocorticoids*

what should you consider giving at time of induction of addisonian patients

**physiologic dose of steroid IV** *0.1-0.2 mg/kg prednisone equivalent*

which drug should be avoided with addisonian patients

Etomidate ## Footnote *causes adrenocortical supression*

how should addisonian patients be monitored

no additional monitoring needed in well controlled patients treat and monitor hypoGLU or lyte abnormalities as indicated - *hyperK, hypogGLU, or fluid deficit should have been corrected **BEFORE** induction*

post-op protocol for addisonian patients

restart chronic PO steroids ASAP monitor for signs of adrenal insufficiency recheck BG and lytes PRN - based on clinical signs

what are some signs of adrenal insufficiency

vomitting, diarrhea, inappetance lethargy, weakness

how should abnormal BG and lytes be treated in post-op addisonian patients

give injectable steroids or increase PO steroids until stable

what are some clinical issues in cushing's patients that have an effect on anesthesia

**hypertension** - loss of autoregulatory control, keep BP higher **hypercoagulability** - susceptible to PTE or thrombosis **hepatomegally** - pressure on diaphragm→hypoventilation **poor immune function and wound healing**

values obtained pre-op in cushings patients

serum CHEM and CBC baseline BP

what can indicate a PTE in cushing patients

sharp drop in EtCO2

post- op care of cushing patients

patients on adrenal suppressive Tx (trilostane) may develop adrenal insufficiency d/t stress ## Footnote *consider low-dose steroid Tx - depends on CS and lab results*

what are some of the risks/complications of pheochromocytoma patients undergoing Sx

tumor produces epi and norepi - tacharrhythmiasm hypertension high vascularity (adhere to vena cava) & potential caecholemine release d/t tumor handling

what should be done pre-op in pheochromocytoma patients

stabilize BP and HR with phenoxybenzamine (long acting alpha antagonist) for several weeks pre-op beta blockers may be used to control HR

T/F alpha blockaid must be in place before beta blockers can be used

**True** if not - beta blockers result in profound vasoconstriction d/t block of beta 2 induced vasdilation (opposing the tumor-induced alpha 1 constrictor effect)

what drugs should be avoided in pheochromocytoma patients

**drugs that cause tachycardia or vasconstriction** *ketamine, alpha 2 agonists, pre-anesthetic atropine (do NOT withhold from bradycardic patients)*

what is the most common beta blocker used and why

Esmolol short-acting, treats tachyarrhythmias

what is used to treat intraoperative vasoconstriction in pheochromocytoma patients

phentolamine - inj. alpha blocker

what can occur once tumor is removed in pheochromocytoma patients

acute drop in catecholemines →bradycardia and hypotension ## Footnote *may be refractory d/t pre-exisiting alpha +/- beta blockaid*

what drugs are used to treat the acute drop in catecholamines post tumor removal in pheochromocytoma patients

dobutamine, ephedrine, phenylephrine

pheochromocytoma patients shoud be hospitalized for _______ post op and have _______ and _______ monitored closely

pheochromocytoma patients shoud be hospitalized for **_at least 48 hours_** post op and have **_ECG_** and **_BP_** monitored closely

T/F phenoxybenzamine should be discontinued post-op in pheochromocytoma patients

**True**

T/F post-op pheochromocytoma patients may become hypoGLU and BG should be monitored closely

**True**