Principles-Management of Endocrine Disorders Flashcards
The main anesthetic concern with somoeone with thyroid is related to what system
cardiovascular
Thyroid hormone causes what principle effect on the CV receptors
Increases its number thereby effecting the tissues reponses to sympathetic stimuli
In primary hyperthyroidism, what changes would you expect for t3,t4, and tsh
t4 increased
t3 increased
tsh decreased
In secondary hyperthyroidism, what changes would you expect for t3, t4, and tsh
t4 increased
t3 increased
tsh increased
In primary hypothyrodism, what changes would you expect for t3, t4, and tsh
t4 decreased
t3 decreased
tsh increased
In secondary hypothyroidsm, what changes would you expect for t3, t4, and tsh
t3 decreased
t4 decreased
tsh decreased
What is the most common cause of hyperthyroidism
Graves disease (a multinodular diffuse goiter)
What are the clinical manifestations of hyperthyroidism
Weight loss diarrhea skeletal muscle weakness warm/moist skin heat intoloerance exophthalmos nervousness
What are the CV manifestations of hyperthyroidism
Increased left ventricular contractility
Increased ejection fraction
Tachycardia
Hypertension
Ideally, what state should the a hyperthyroid patient be in prior to surgery
Euthyroid
What four medications are used to treat hyperthyroidism
Beta-adrenergic antagonists
Iodine
Methimazole
Propylthiouracil
A SYMPTOMATIC hyperthyroid patient requiring emergency surgery should receive
beta blockers to achieve a HR < 90
Should hyperthroid patients continue therapy up to the morning of surgery
Yes
Are Euthyroid patients considered normal for anesthesia
yes
What is the main goal for treating symptomatic hyperthyroid patients
Prevent exagerrated sympathetic response
-avoid medications that increase SNS discharge
Name a NDMB that should be avoided in hyperthyroid patients
pancuronium
Name an induction agent that should be avoided in symptomatic hyperthyroid patients
Ketamine
Name a inhaled induction agent that should be avoided in the symptomatic hyperthyroid patient
Rapid titration of desflurane
The incidence of what neuromuscular disease is increased with hyperthyroid patients
Myasthenia Gravis
Treating hypotension for symptomatic hyperthyroidism should be done with what
Direct-acting vasopressors
Name commonly used Direct-acting vasopressors
Phenylephrine
Epinenephrine
Norepineprine
Is there a change in MAC with hyperthyroid patients
NO!!!
Thiopental has what activity due to its structure
antithyroid
Fluroide nephrotoxicity is a potential with hyperthyroid patients related to
Sevoflurane administration and increased metabolic rate which leads to increased metabolism of sevo
*Sevo metabolized 2-5% normally
Nitrous Oxide should be used cautiously because
PTU/Methimazole causes bone marrow suppression and can be exaccerbated with N20
Should you reverse a hyperthyroid patient with anticholinergic
YES!!! but give slowly to avoid tachycardia
What condition is considered a hyperthyroid emergency
Thyroid storm
What is the Differential Diagnosis with thyroid storm
MH
NMS
Pheochromocytoma
Light anesthesia
*Always err on the most catastrophic diagnosis
What are the manifestations of thyroid storm
Hyperthermia Tachycardia Dysrhytmias Myocardial ischemia CHF agitation/confusion
Onset of thyroid storm appears
6-24 hours post surgery