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RUSVM Anesthesiology > Anesthesia for Endocrine Disorders > Flashcards

Anesthesia for Endocrine Disorders Flashcards

1
Q

what is required before emergency anesthesia of a DKA patient

A

agressive fluid replacement

regular insulin therapy

dextrose and potassium supplementation

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2
Q

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

A

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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3
Q

what should be checked before induction of a DM patient

A

blood glucose

treat hypoglycemia as needed - verify normoglycemia before administering anesthetic drugs

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4
Q

which class of drug should be avoided in DM patients

A

alpha 2 agonists

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

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5
Q

what drug protocol should be used for DM patients

A

short-acting drugs or those that can be reversed

goal is to resume normal feeding and insulin schedule ASAP

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6
Q

how often should blood glucose be check while under anesthesia

A

q 30-60 min (depends on initial values)

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7
Q

blood glucose should be maintained between ___________mg/dl

A

150-250 mg/dl

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8
Q

what fluids should be used in DM patients

A

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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9
Q

How often should BG be check post op in DM patients

A

q 1-2 hours until patient is eating

continue fluids with dextrose PRN

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10
Q

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

A

high blood glucose stimulates insulin release from the tumor

patients are adapted to low BG

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11
Q

where should you keep blood glucose in insulinoma patients

A

>50 mg/dl

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12
Q

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

A

True

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13
Q

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

A

glucagon

promotes gluconeogenesis and glycogenolysis

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14
Q

what drugs are contraindicated in insulinoma patients

A

none - no specific contraindications

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15
Q

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

A

Na

maintain <160 mEq/L

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16
Q

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

A

may cause fatal brain damage (central pontine myelinolysis)

DO NOT DO THIS…..EVER!

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17
Q

__________ fluids should be used as necessary in DI patients

A

hypotonic

  • 5% dextrose in water (D5W)*
  • 0.45% NaCl + 2.5% dextrose*
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18
Q

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

A

hypothyroid

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19
Q

drug protocol for hypothyroid animals

A

conservative doses

reversible drugs

no specific contraindications

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20
Q

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

A

thickened myocardium - thyrotoxic cardiomyopathy

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21
Q

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

A

“Thyroid storm” - catecholamine release

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22
Q

how should hyperthyroid animals be treated pre-op

A

stabilized before elective procedures

minimize stress

Tx of hyperT may unmask renal disease

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23
Q

why should ketamine and routine anticholinergics be avoided in hyperT patients

A

increase HR, myocardial work, and O2 consumption

anticholinergics should NOT be withheld in bradycardic patients

24
Q

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

A

acepromazine

alpha 2 agonists

25
Q

why should mask/chamber induction be avoided in hyperT patients

A

high stress

26
Q

what can be used to manage HR in hyperT patients

A

opioids and benzodiazepines

27
Q

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

A

>70 mmHg

kidneys used to higher MAP and are less able to compensate for anesthesia induced hypotension (impaired autoregulation)

28
Q

what can be used for BP support in hyperT patients

A

dopamine

29
Q

what should be decreased before anesthesia in hyperPTH patients

A

serum iCa

Fluid therapy with 0.9% NaCl, Diuretics, Steroids

30
Q

marked, chronic hyperCa can lead to ________

A

ventricular arrhythmias

rapid development of V fib possible at the time of induction

31
Q

what drugs should be avoided in hyperPTH

A

long-acting

significant CV effects

32
Q

what frequently happens post-op with hyperPTH patients

A

hypoCa

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

33
Q

how recent should bloodwork be preformed in addisonian patients

A

<24 hours pre-op

primary concern = BG and lytes

34
Q

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

A

False

continue administering scheduled PO gluco- or minalocorticoids

35
Q

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

A

physiologic dose of steroid IV

0.1-0.2 mg/kg prednisone equivalent

36
Q

which drug should be avoided with addisonian patients

A

Etomidate

causes adrenocortical supression

37
Q

how should addisonian patients be monitored

A

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

38
Q

post-op protocol for addisonian patients

A

restart chronic PO steroids ASAP

monitor for signs of adrenal insufficiency

recheck BG and lytes PRN - based on clinical signs

39
Q

what are some signs of adrenal insufficiency

A

vomitting, diarrhea, inappetance

lethargy, weakness

40
Q

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

A

give injectable steroids or increase PO steroids until stable

41
Q

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

A

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

42
Q

values obtained pre-op in cushings patients

A

serum CHEM and CBC

baseline BP

43
Q

what can indicate a PTE in cushing patients

A

sharp drop in EtCO2

44
Q

post- op care of cushing patients

A

patients on adrenal suppressive Tx (trilostane) may develop adrenal insufficiency d/t stress

consider low-dose steroid Tx - depends on CS and lab results

45
Q

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

A

tumor produces epi and norepi - tacharrhythmiasm hypertension

high vascularity (adhere to vena cava) & potential caecholemine release d/t tumor handling

46
Q

what should be done pre-op in pheochromocytoma patients

A

stabilize BP and HR with phenoxybenzamine (long acting alpha antagonist) for several weeks pre-op

beta blockers may be used to control HR

47
Q

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

A

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)

48
Q

what drugs should be avoided in pheochromocytoma patients

A

drugs that cause tachycardia or vasconstriction

ketamine, alpha 2 agonists, pre-anesthetic atropine (do NOT withhold from bradycardic patients)

49
Q

what is the most common beta blocker used and why

A

Esmolol

short-acting, treats tachyarrhythmias

50
Q

what is used to treat intraoperative vasoconstriction in pheochromocytoma patients

A

phentolamine - inj. alpha blocker

51
Q

what can occur once tumor is removed in pheochromocytoma patients

A

acute drop in catecholemines →bradycardia and hypotension

may be refractory d/t pre-exisiting alpha +/- beta blockaid

52
Q

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

A

dobutamine, ephedrine, phenylephrine

53
Q

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

A

pheochromocytoma patients shoud be hospitalized for at least 48 hours post op and have ECG and BP monitored closely

54
Q

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

A

True

55
Q

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

A

True

RUSVM Anesthesiology (39 decks)

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