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Anes& Coex > Endocrine > Flashcards

Endocrine Flashcards

1
Q

S/s Graves’ disease/hyperthyroid

A

Anxiety Fatigue Muscle weakness Weight loss Diarrhea Heat tolerance Diaphoresis Tachydysrhythmias Exophthalmos Goiter

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2
Q

Preop prep hyperthyroid.

A

Check labs for euthyroid, ekg normal, bb po preop, continue all drugs

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3
Q

Drug tx hyperthyroid

A

Bb (Prop/aten/metop/nad), antithyroid (methimazole/PTu/carbimazole), iodide containing solutions (k iodide, lugols sol, lithium, glucocorticoids)

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4
Q

Management of hyperthyroid pt if emergent sx

A

Esmolol 100-300ug/kg/min gtt. Thyrotoxicosis- an excessive amt of thyroid hormone. May be an exogenous source with a normal thyroid gland.

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5
Q

Thyroid storm: sign, often confused with

A

Temp elevated as high as 105-106 f. MG, pheo, neurleptic malignant syndrome, sepsis

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6
Q

Thyroid storm management

A

Cooled crystalloid, esmolol gtt, ptu, k iodide

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7
Q

Airway assessment hyperthyroid

A

Ct, x ray, voice, swallowing, tracheomalacia from goiter, isthmus over 2-4th tracheal rings, may be difficult a/w

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8
Q

What to do for difficult a/w

A

Sedation, awake intub, a/w block, difficult a/w cart

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9
Q

Preop meds hyperthyroid: avoid what, give what

A

Anticholinergics (avoid). Give 2-5 mg versed. Avoid hypercarbia (stim sns), avoid hypoxia (inc metabolic demands)

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10
Q

Induction consid hyperthyroid

A

Pre oxygenate well (hypermetabolism), VS Normal/adequate sedation, avoid oversedation. Good drugs: thiopental, propofol. NO ketamine.

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11
Q

Induction equip hyperthyroid

A

Reinforced tube, Rae, nasal intub may be req, extensions, access to difficult a/w cart

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12
Q

Muscle relaxants for hyperthyroid, what else to atten sns

A

Depolarizers (sux). Non-dep avoid panc. Ensure complete relaxation to avoid bucking. Xylocaine iv or LTA

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13
Q

Positioning thyroidectomy

A

Supine w arms tucked. IV each arm (2nd after induction). Extension tubing

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14
Q

Maintenance hyperthyroid: goal, anes fx, avoid what

A

Goal to avoid sns stim. 5% inc MAC w each 1 degree over 37 degrees. Avoid local w epi

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15
Q

Monitoring for hyperthyroid

A

Recog sns stim, cooling devices, eye protection, iv infiltration, muscle relaxants, treat hypotension w fluids or lightening anesthesia first. Then ephedrine (exag response to direct acting drugs)

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16
Q

Emergence for hyperthyroid consid

A

Thyroidectomy- concern of VC paralysis. Damage to abductor fibers of laryngeal nerve (bilateral= obstruction, uni= hoarse). Weak rings if tracheomalacia. Awake but no bucking- xylocaine.

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17
Q

Possible complications after surgery w hyperthyroid

A

Thyroid storm (emergency), thyroidectomy: a/w obstruc from nerve damage, tracheomalacia, hemorrhage, hypoparathyroidism- hypocalcemia

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18
Q

Cardiac consid of hypothyroid pts

A

Bradycardia, dec CO/SV/contractility. Inc SVR/BP, narrow PP. CHF occasionally. Dec EKG voltage, prolonged PR/QRS/QTi. Potential for pericardial effusion and conduc abn

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19
Q

Hypothyroid respiratory effects

A

Decreased response to hypoxia and hypercapnia

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20
Q

Renal effects hypothyroid

A

SIADH, hyponatremia, inability to excrete free water

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21
Q

Pre op hypothyroid consid

A

Airway (goiter, macroglossia, puffy face). Cv: low hr, dec SV, cold intolerance, vasoconstriction peripherally. Delayed gastric emptying

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22
Q

Hypothyroid: possible adverse responses in anesthesia

A

Inc sensitivity to depressants, slow metab, unresponsive baroreceptor reflex. Dec resp to hypoxia/hypercapnia. Hypovolemia, anemic, hypoglycemia

23
Q

Hypothyroid: postpone if what. Med considerations to plan for

A

No replacement tx/not being managed. Adrenal insuff, avoid of 1/2 dose of benzos, fluid replacement, RSI if reflux

24
Q

Regional considerations for hypothyroid

A

Decrease dose in pn block. Metabolism of local may be delayed- toxicity possible

25
Q

Induction considerations hypothyroid: room management, etc

A

Avoid sedation for transfer. Warm blankets. HOB up and pre ox for ventilation.

26
Q

Induction drugs that are good or not for hypothyroid

A

Ketamine good (low dose). Thiopental- low dose. Propofol- hypotension potential

27
Q

Intubation consid hypothyroid

A

Goiter- difficult a/w cart. Prolonged response to relaxants- titrate w nerve stim. RSI w sux

28
Q

Maintenance hypothyroid

A

N20 or w low dose benzos/opioids/ketamine. Maintain body temp. Controlled vent.

29
Q

Monitoring hypothyroid intraop: early recog of what, tx w what

A

Cardiac depression, CHF, hypothermia. Tx low bp w 2.5-5 mg ephedrine

30
Q

Hypothyroid emergence considerations

A

Delayed recovery: difficulty weaning from vent, hypothermia may delay metab of muscle relaxant

31
Q

Hyperparathyroidism: hallmark. NM fx. Renal fx.

A

Hypercalcemia. Muscle weakness. Polyuria, polydipsia, dec GFR, kidney stones

32
Q

Hyperparathyroid: cv and GI fx

A

Prolonged PR, short QTi, htn, anemic. Vomiting, abd pain, PUD, pancreatitis

33
Q

Hyperparathyroid: skeletal, NS, ocular fx

A

Demineralization, vertebral collapse, fractures. Somnolent, dec pain sens, psychosis. Calcifications and conjunctivitis

34
Q

Hyperparathyroid: manage what preop

A

Hypercalcemia w nacl 150 ml/hr if symptomatic. Lasix to inhib na and ca reabs

35
Q

Anes consid intraop hyperthyroid

A

Somnolent- less induc meds, less pain sens, avoid ketamine. Intub- Rae tubing, extensions. Extension on IV tubing, no LR (Ca), monitor UOP

36
Q

Hyperparathyroid: muscle relaxant consid, renal consid w VA choice

A

Unpredictable response- dec dose and use stim. Avoid sevo and enflurane d/t dec GFR

37
Q

Hypoparathyroidism: chronic issues

A

Fatigue, muscle cramps, prolonged QT, normal QRS/PR/rhythm. Tired, personality changes

38
Q

Hypoparathyroidism: acute changes (w removal)

A

Oral parasthesias, restless, NM irritability, + chvostek’s/trousseau, a/w stridor

39
Q

Chvosteks, trousseau

A

C- twitch of face w tap. T- compression of FA produces spasm of hand and wrist

40
Q

Hypoparathyroidism pre op management

A

Check labs. 10 ml 10% ca gluc until symptoms go away. Thiazides diuretics deplete na and k, inc ca.

41
Q

Hypoparathyroid: induction consid

A

Low end dosing (tired). Rae tube. IV extension.

42
Q

Hypoparathyroidism: intra op management

A

Avoid further ca dec. No rapid/MTP, no hyperventilation. Give 1-4g ca cl/ca gluc iv

43
Q

CM DM

A

Polydipsia/phagia/uria. Recurrent infections. Visual changes. Parasthesias, tired

44
Q

IDDM anesthesia: fast, intermediate, long acting

A

Fast: regular/humalog/semilente. Intermediate: NPH and lente. Long: protamine zinc and ultralente

45
Q

NIDDM consid: meds and what they do

A

Metformin- inc sensitivity to insulin. Acarbose- delays digestion of carbs. Sulfonylureas- hypoglucemia up to 50 hrs after- inc fx of barbs, tolbutamide metab from liver, chlorpropramide renal excretion dependent

46
Q

Stiff joint syndrome: which disease and considerations

A

IDDM. Ltd joint mobility- difficult laryngoscope d/t atlanto occipital mobility dec and laryngeal rigidity

47
Q

Diabetic autonomic neuropathy: effects which systems and how

A

Cv and GI. Ortho hypo, resting tachycardia, periph neurop, loss of HR variability, dysrhythmias, gastroparesis, alt reg of breathing, sudden death syndrome

48
Q

Preop eval of DM

A

Type of dm, duration, daily tx. Complic: renal, nerves, gastroparesis, autonomic neuropathy, infec, htn, cv disease

49
Q

Preop eval dm: what labs/tests to check specifically

A

Pre op ecg, lytes, a1c, stiff joint syndrome. Bg in holding area, may cancel if >300 and not normal for pt

50
Q

Anesthesia consid DM

A

Schedule early in day, difficult intub, may do RSI, 50-100% 02 for cv disease, glucometer for bg. Avoid nephrotoxic agents, inc sens to cv depressants, may do regional. Aggressively tx Brady w epi if autonomic neurop

51
Q

Reasons to do tight control

A

Type 1 dm. Inc healing, dec infec, Dec osmotic diuresis, dec incidence DKA

52
Q

Nontight DM management

A

Fbg am of sx. IV d5w 100-125 ml/hr. 30-50% am insulin intermediate sq. Bg q1-2 hrs, adjust d5 accordingly. If bg >200 give iv insulin on sliding scale. 1 u drops bg 50 mg

53
Q

How tight control is done

A

Fasting bg. D5w on pump 100-150 ml/hr. 2nd started w normal fluid. 50 u ins in 250 bag, divide hourly. Bg by 150 to get rate. Check k levels, add 20 meq to each l of glucose

54
Q

Regional considerations dm

A

Ineffective in area of infection. Concern if autonomic neurop: peripheral neurop, hypotension

Anes& Coex (15 decks)

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