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RUSVM Anesthesiology > Endocrine Disease > Flashcards

Endocrine Disease Flashcards

1
Q

What are the clinical signs and biochem findings in a patient with diabetes mellitus?

A

PU/PD/PP (with weight loss )
Cataracts

Hyperglycemia
Glucosuria
Increase ALP

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2
Q

What would you do pre-op for a patient that has diabetes mellitus?

A

CBC and chem
Procedure first thing in the morning

Routine overnight fast(8-12hrs), give 1/2 of normal AM insulin dose
-NEVER withhold water

Check BG before induction, treat hypoglycemia as needed

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3
Q

What drugs should be avoided in diabetes mellitus patients?

A

A2-agonsits —> can cause hyperglycemia via inhibition of insulin release or stimulation of glucagon release

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4
Q

Blood glucose should be checked every 30-60mins. What should the BG be maintained between?

A

150-250mg/ml

Use 1-5% dextrose in balanced electrolyte solution

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5
Q

How do you monitor/recover a diabetic patient post-op?

A

Monitor BG every 1-2hrs until patient is eating

Return to normal feeding an insulin schedule ASAP

If patient is anorexic, insulin dose will need to be adjusted

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6
Q

How would you stabilized a dog with an insulioma prior to surgery?

A

Frequent feeding
Glucocorticoids (promotes gluconeogensis)
Diazoside (inhibit insulin release)

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7
Q

During surgery, you monitor an insuloma patient the same as you would a diabetic patient. Why would you be concerned about over supplanting dextrose?

A

High blood glasses stimulates insulin release from tumor

Keep BG> 50mg/ml

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8
Q

What could you give to your insulinoma patient if you are unable to maintain BG with dextrose and glucocorticoids ?

A

Glucagon —> promote gluconeogensis and glycogenolysis

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9
Q

In a patient with diabetes insipidus, what are you monitoring before and during surgery?

A

Na levels
Maintain <160meq/L

  • do NOT increase/decrease Na foster than 0.5meq/L per hour
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10
Q

What fluids are used to correct Na abnormalites in diabetes insipidus?

A

Hypotonic fluids

  • 5%dextrose in water
  • 0.45% NaCl + 2.5% dextrose
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11
Q

T/F: patients with diabetes insipidus are feed and water restricted prior to surgery

A

False

Fasting yes
NEVER restricted water —> lack of ability to concentrate urine —> hypernatremia

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12
Q

Are there any specific drug contraindications to anesthesia of a dog with hypothyroidism? How would you modify your anesthesia approach?

A

None

Decreased metabolic rate
Bradycardia, hypothermia, and hypoventialion more likely

-> use conservative doses and reversible drugs

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13
Q

How would you prepare a hyperthyroid cat for anesthesia?

A

Treat and stabilize before elective procedure
Minimize stress

Treating often unmask renal disease

Thyroid storm possible —> catecholamine release which increases HR, BP, arrhythmia, and hyperthermia (B blocker)

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14
Q

What drugs would you avoid in hyperthyroid cats and why?

A

Ketamine and anticholinergics —> increase HR, myocardial work, and oxygen consumption

Acepromazine and A2-agonsits —> significant CV changes

Chamber/mask induction —> high stress

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15
Q

In hyperthyroid cats, we want to avoid tachycardia, what drugs do we use to manage HR?

A

Opioid and benzodiazepines

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16
Q

If patient is normally hypertensive or has renal compromise, we want to keep MAP _________mmHg.

What drug can be used to support BP

A

> 70

Dopamine

17
Q

In hyperparathyroid animals, surgery is indicated to remove parathyroid tumor. What would you do before surgery in this patient?

A

DECREASE serum Ca

  • fluid therapy with 0.9% NaCl
  • diuretic
  • steroids
18
Q

Hypocalcemia is common post-op from removal of parathyroid tumor. How would you treat?

A

Ca gluconate
PO calcium

As needed

19
Q

Addison’s disease patients have decreased production of?

A

Glucocorticoids and mineralocorticoids by adrenal glands

20
Q

Addisons patients are generally treated with Percorten +/- a glucocorticoid. Do you recommend any dose changes prior to anesthesia ?

A

Continue administering gluco-/mineralocorticoids the morning of surgery

Pre-op consider giving a physiologic dose of steroid IV at time of induction

21
Q

What induction drug is contraindicated in addisons patients?

A

Etomidate —> causes adrenocortical suppression

22
Q

What should you be monitoring for in hypoadrenocorticism patients?

A

Treat and monitor hypoglycemia/electrolyte abnormalites prior to anesthesia and based on clinical signs

Monitor signs of adrenal insufficiency

  • vomiting, diarrhea, inappetence
  • lethargy, weakness
23
Q

What clinical complications does cushings cause ?

A

Hypertension —> keep BP higher during anesthesia.

Hypercoagulability —> PTE or thrombus

Hepatomegaly—> pressure on diaphragm can cause hypoventilation

Poor immune function and wound healing

24
Q

T/F: a normally hypertensive patient should have a higher BP while under anesthesia

A

True

—kidneys may lose autoregulatory ability so maintaining higher BP will help prevent renal injury

25
Q

How can you monitor for pulmonary thromboembolism ?

A

sharp drop in CtCO2

26
Q

Patients undergoing adrenal-suppressive treatment may develop adrenal insufficiency perioperatively d/t stress. How would you manage this?

A

Consider low-dose steroid treatment

27
Q

What is a pheochromocytoma?

A

Tumor of adrenal medulla, producing epi and norepi

—-> tachyarrythmias and hypertension

28
Q

How would you stabilize BP and HR pre-op for removal of a pheochromocytoma ?

A

Phenoxybenzmine (long acting A antagonist) —> decrease BP

B blocker to control HR

MUST give phenoxybenzmine before B blocker or the B blocker will cause vasconcontriciton by blocking B2

29
Q

What drugs that cause tachycardia/vasoconstriction would you NOT use with pheochromocytoma ?

A

Ketamine
A2 agonist

Pre-anesthetic atropine (but do not withhold from bradycardic patient)

30
Q

What is the most common B blocker used in pheochromocytoma ?

A

Esmolol

31
Q

What can you used intraoperatively to reduce BP in pheochromocytoma surgery?

A

Phentolamine

32
Q

Once pheochromocytoma is removed, a acute drop in catecholamines may occur. What would you administer int this case?

A

Causes hypotension and bradycardia

—> dobutamine, ephedrine, and phenylephrine

RUSVM Anesthesiology (32 decks)

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