Endocrine Disease

Question 1

When should diabetes mellitus patients not be anesthetized unless absolutely necessary?

Answer 1

those with diabetic ketoacidosis

Question 2

What should be done at pre-op for a patient with diabetes mellitus?

Answer 2

• CBC and chem with electrolytes
• overnight fast (8-12 hours)
• 1/2 normal AM insulin dose
• verify normoglycemia

Question 3

Which drugs should be avoided in patients with diabetes mellitus and why?

Answer 3

alpha-2 agonists

can cause hyperglycemia

Question 4

What types of drugs should be used for diabetes mellitus patients?

Answer 4

short-acting or reversible drugs

Question 5

What should be done at post-op for a patient with diabetes mellitus?

Answer 5

• monitor blood glucose until patient is eating

- return to normal feeding and insulin ASAP

Question 6

What should be done at pre-op for a patient with an insulinoma?

Answer 6

• frequent feeding
• glucocorticoids
• Diazoxide to inhibit insulin release

Question 7

What should be done/monitored for a patient with diabetes insipidus?

Answer 7

• 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

Question 8

What conditions can happen during surgery in a patient with hypothyroidism?

Answer 8

bradycardia
hypothermia
hypoventilation

Question 9

What happens during a thyroid storm?

Answer 9

• catecholamine release

- increased HR, BP, arrhythmias, and hyperthermia

Question 10

Which drugs should be avoided in a patient with hyperthyroidism?

Answer 10

• drugs that increase HR, myocardial work, and oxygen consumption
  (ketamine, anticholinergics)
• drugs resulting in significant CV changes
  (acepromazine, alpha-2 agonists)

Question 11

What should be done pre-op for a patient with hyperparathyroidism?

Answer 11

serum iCa should be decreased

• fluid therapy with 0.9% NaCl
• diuretics, steroids

Question 12

Which drugs should be avoided in patients with hyperparathyroidism?

Answer 12

long-acting drugs or those that cause significant CV effects

Question 13

What can occur in a patient with hypoadrenocorticism?

Answer 13

hypoglycemia
hyperkalemia
hyponatremia
hypovolemia
increased BUN

Question 14

What should be done at pre-op for a patient with hypoadrenocorticism?

Answer 14

• bloodwork (BG and electrolytes)

- continue administration of corticoids the morning of surgery

Question 15

Which drug should be avoided in hypoadrenocortism, and why?

Answer 15

etomidate due to adrenal suppression

Question 16

What can occur in patients with hyperadrenocorticism?

Answer 16

hypertension
hypercoagulability
hepatomegaly
poor immune function and wound healing

Question 17

What should be done at pre-op for patients with hyperadrenocorticism?

Answer 17

• serum chem and CBC

- baseline blood pressure

Question 18

What should be done/monitored during surgery for a patient with hyperadrenocorticism?

Answer 18

• keep BP high to prevent renal injury

- monitor for pulmonary thromboembolism

Question 19

What is pheochromocytoma?

Answer 19

tumor of adrenal medulla producing epinephrine and norepinephrine
- causes tachyarrhythmias and hypertension

Question 20

What should be done at pre-op for a patient with pheochromocytoma?

Answer 20

• stabilize BP and HR with phenoxybenzamine
• beta-blocker to control HR
• alpha blockade before beta blockers to prevent vasoconstriction

Question 21

Which drugs should be avoided in patients with pheochromocytoma?

Answer 21

drugs causing tachycardia or vasoconstriction

ketamine, alpha-2 agonists, atropine

Question 22

What can occur once a pheochromocytoma is removed?

Answer 22

acute drop in catecholamines leading to hypotension and bradycardia