Endocrine Flashcards
Why may diabetes patients have a difficult airway? (2)
• Glycosylation of temperomandibular junction (limited mouth opening) and cervical spine (limited extension)
• features of autonomic dysfunction (alert you to Cv instability and aspiration risk intra-op)
Glucose goal for diabetics intra -op?
6-10 mmol/l
Treatment DKA? (5)
•1-2L ns iv bolus followed by 200-500 ml/hr
• insulin 0,1 u/kg/h iv infusion
• replace k because insulin drives it ( and glucose) intracellularly
• once plasma glucose 14, start d5W infusion.
• treat precipitating cause
Name 4 treatment options for hyperthyroidism
• Carbimazole (inhibit thyroid hormone systhesis)
• propranolol (inhibit t4 to t3 conversion, treat symptoms)
• radioactive iodine (thyroid ablation)
• thyroidectomy
When can thyroid disease patients have elective surgery?
Only when euthyroid clinically and biochemically!
Which special precautions and contraindications must be followed intra-op for hyperthyroid patients? (4)
• Avoid sympathetic stimulation! (Blunt intubation response) - ketamine contraindicated (increase metabolic rate)
• expect labile blood pressures
• careful eye care due to exophthalmos
• no increase in anaesthetic requirements
Treatment thyroid storm? (5)
• Propothiouracil (decrease production thyroid hormone)
• potassium iodide (decrease secretion)
• esmolol (iv beta blocker)
• cortisol
• active cooling
Medical emergency! Present 6-24h post op
What may cause airway obstruction in hyperthyroid patients post-op? (3)
• neck haematoma
• recurrent laryngeal nerve injury
• tracheomalacia
Which special precautions and contraindications must be followed intra-op for hypothyroid patients? (2)
• More prone to hypotension (decreased co, blunt baroreflex, decreased intravascular volume) (consider invasive bp monitor)
• consider co-existing primary adrenal insufficiency if hypotension persist (treat with cortisol)
Name 4 possible post-op complications hypothyroid patients
• Delayed emergence due to respiratory depression
• hypothermia
• myxedema coma: impaired loc, hypoventilation, hypothermia, hypo na, Ccf
Slow drug biotransformation
Fluctuating BP
Name 6 anatomical differences in obese patients that may make anaesthesia difficult
• Difficult BMv (bones)
• difficult intubation (increased risk cricothyroidotomy, also difficult)
• difficult venous access
• difficult regional anaesthesia
• difficult monitoring
• careful positioning - small operating table etc
Name 4 cardiovascular physiological differences in obese patients that may make anaesthesia difficult
• associated comorbids of metabolic syndrome
• increase risk IHD
• OSA: cause pulmonary ht and RH failure
• increase blood volume and cardiac output (0,1L/min/kg of adipose tissue)
Name 6 respiratory physiological differences in obese patients that may make anaesthesia difficult
• Increased oxygen consumption and CO2 production therefore desaturate easily and quickly
• increase mv due to increase metabolic rate
• decrease FRC due to diaphragm pushed cephalad
• decreased chest wall compliance (restrictive lung disease)
•OSA
• obesity hypoventilation syndrome
Name the stop-bang criteria for OSA and interpretation
4 or more:
• Snoring
• Tiredness
• observed apnoea
• pressure ht
• BMI >30
• age >50
• neck circumference >45 cm
• gender male
Name 2 gastrointestinal physiological differences in obese patients that may make anaesthesia difficult
• Hiatus hernia, gord, delayed gastric emptying all causing increased risk aspiration
. Fatty infiltration liver affecting drug metabolism