Endocrine

Question 1

Identify the two major perioperative goals for the patient with Graves’ disease

Answer 1

make the patient euthyroid before surgery, if possible. The other major goal is to prevent sympathetic nervous system stimulation. This is accomplished by providing sufficient anesthetic depth and avoiding medications that directly or indirectly stimulate the sympathetic nervous system

Question 2

Your patient with Graves’ disease has achieved euthyroid state and has no evidence of airway obstruction. What is the best induction method for this patient?

Answer 2

induction in the euthyroid patient with Graves’ disease may be achieved with a number of IV agents. No controlled study has shown an advantage of any induction drug over another. Because of the increased incidence of myasthenia gravis and skeletal muscle weakness in the hyperthyroid patient, precaution dictates careful titration of muscle relaxant doses with use of a peripheral nerve stimulator.

Question 3

which agents must be avoided during induction in the patient with Graves’ disease?

Answer 3

avoid Ketamine because it is a CNS stimulant, also avoid pancuronium– it increases heart rate