Endocrine Disease Flashcards
When should diabetes mellitus patients not be anesthetized unless absolutely necessary?
those with diabetic ketoacidosis
What should be done at pre-op for a patient with diabetes mellitus?
- CBC and chem with electrolytes
- overnight fast (8-12 hours)
- 1/2 normal AM insulin dose
- verify normoglycemia
Which drugs should be avoided in patients with diabetes mellitus and why?
alpha-2 agonists
can cause hyperglycemia
What types of drugs should be used for diabetes mellitus patients?
short-acting or reversible drugs
What should be done at post-op for a patient with diabetes mellitus?
- monitor blood glucose until patient is eating
- return to normal feeding and insulin ASAP
What should be done at pre-op for a patient with an insulinoma?
- frequent feeding
- glucocorticoids
- Diazoxide to inhibit insulin release
What should be done/monitored for a patient with diabetes insipidus?
- check Na before induction and every hour
- maintain Na below 160 mEq/L
- do not change Na faster than 0.5 mEq/L per hour
- use hypotonic fluids
What conditions can happen during surgery in a patient with hypothyroidism?
bradycardia
hypothermia
hypoventilation
What happens during a thyroid storm?
- catecholamine release
- increased HR, BP, arrhythmias, and hyperthermia
Which drugs should be avoided in a patient with hyperthyroidism?
- drugs that increase HR, myocardial work, and oxygen consumption
(ketamine, anticholinergics) - drugs resulting in significant CV changes
(acepromazine, alpha-2 agonists)
What should be done pre-op for a patient with hyperparathyroidism?
serum iCa should be decreased
- fluid therapy with 0.9% NaCl
- diuretics, steroids
Which drugs should be avoided in patients with hyperparathyroidism?
long-acting drugs or those that cause significant CV effects
What can occur in a patient with hypoadrenocorticism?
hypoglycemia hyperkalemia hyponatremia hypovolemia increased BUN
What should be done at pre-op for a patient with hypoadrenocorticism?
- bloodwork (BG and electrolytes)
- continue administration of corticoids the morning of surgery
Which drug should be avoided in hypoadrenocortism, and why?
etomidate due to adrenal suppression
What can occur in patients with hyperadrenocorticism?
hypertension
hypercoagulability
hepatomegaly
poor immune function and wound healing
What should be done at pre-op for patients with hyperadrenocorticism?
- serum chem and CBC
- baseline blood pressure
What should be done/monitored during surgery for a patient with hyperadrenocorticism?
- keep BP high to prevent renal injury
- monitor for pulmonary thromboembolism
What is pheochromocytoma?
tumor of adrenal medulla producing epinephrine and norepinephrine
- causes tachyarrhythmias and hypertension
What should be done at pre-op for a patient with pheochromocytoma?
- stabilize BP and HR with phenoxybenzamine
- beta-blocker to control HR
- alpha blockade before beta blockers to prevent vasoconstriction
Which drugs should be avoided in patients with pheochromocytoma?
drugs causing tachycardia or vasoconstriction
ketamine, alpha-2 agonists, atropine
What can occur once a pheochromocytoma is removed?
acute drop in catecholamines leading to hypotension and bradycardia
