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Anes& Coex > Endocrine > Flashcards

Endocrine Flashcards

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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

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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

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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

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A

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

25
Induction considerations hypothyroid: room management, etc
Avoid sedation for transfer. Warm blankets. HOB up and pre ox for ventilation.
26
Induction drugs that are good or not for hypothyroid
Ketamine good (low dose). Thiopental- low dose. Propofol- hypotension potential
27
Intubation consid hypothyroid
Goiter- difficult a/w cart. Prolonged response to relaxants- titrate w nerve stim. RSI w sux
28
Maintenance hypothyroid
N20 or w low dose benzos/opioids/ketamine. Maintain body temp. Controlled vent.
29
Monitoring hypothyroid intraop: early recog of what, tx w what
Cardiac depression, CHF, hypothermia. Tx low bp w 2.5-5 mg ephedrine
30
Hypothyroid emergence considerations
Delayed recovery: difficulty weaning from vent, hypothermia may delay metab of muscle relaxant
31
Hyperparathyroidism: hallmark. NM fx. Renal fx.
Hypercalcemia. Muscle weakness. Polyuria, polydipsia, dec GFR, kidney stones
32
Hyperparathyroid: cv and GI fx
Prolonged PR, short QTi, htn, anemic. Vomiting, abd pain, PUD, pancreatitis
33
Hyperparathyroid: skeletal, NS, ocular fx
Demineralization, vertebral collapse, fractures. Somnolent, dec pain sens, psychosis. Calcifications and conjunctivitis
34
Hyperparathyroid: manage what preop
Hypercalcemia w nacl 150 ml/hr if symptomatic. Lasix to inhib na and ca reabs
35
Anes consid intraop hyperthyroid
Somnolent- less induc meds, less pain sens, avoid ketamine. Intub- Rae tubing, extensions. Extension on IV tubing, no LR (Ca), monitor UOP
36
Hyperparathyroid: muscle relaxant consid, renal consid w VA choice
Unpredictable response- dec dose and use stim. Avoid sevo and enflurane d/t dec GFR
37
Hypoparathyroidism: chronic issues
Fatigue, muscle cramps, prolonged QT, normal QRS/PR/rhythm. Tired, personality changes
38
Hypoparathyroidism: acute changes (w removal)
Oral parasthesias, restless, NM irritability, + chvostek's/trousseau, a/w stridor
39
Chvosteks, trousseau
C- twitch of face w tap. T- compression of FA produces spasm of hand and wrist
40
Hypoparathyroidism pre op management
Check labs. 10 ml 10% ca gluc until symptoms go away. Thiazides diuretics deplete na and k, inc ca.
41
Hypoparathyroid: induction consid
Low end dosing (tired). Rae tube. IV extension.
42
Hypoparathyroidism: intra op management
Avoid further ca dec. No rapid/MTP, no hyperventilation. Give 1-4g ca cl/ca gluc iv
43
CM DM
Polydipsia/phagia/uria. Recurrent infections. Visual changes. Parasthesias, tired
44
IDDM anesthesia: fast, intermediate, long acting
Fast: regular/humalog/semilente. Intermediate: NPH and lente. Long: protamine zinc and ultralente
45
NIDDM consid: meds and what they do
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
Stiff joint syndrome: which disease and considerations
IDDM. Ltd joint mobility- difficult laryngoscope d/t atlanto occipital mobility dec and laryngeal rigidity
47
Diabetic autonomic neuropathy: effects which systems and how
Cv and GI. Ortho hypo, resting tachycardia, periph neurop, loss of HR variability, dysrhythmias, gastroparesis, alt reg of breathing, sudden death syndrome
48
Preop eval of DM
Type of dm, duration, daily tx. Complic: renal, nerves, gastroparesis, autonomic neuropathy, infec, htn, cv disease
49
Preop eval dm: what labs/tests to check specifically
Pre op ecg, lytes, a1c, stiff joint syndrome. Bg in holding area, may cancel if >300 and not normal for pt
50
Anesthesia consid DM
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
Reasons to do tight control
Type 1 dm. Inc healing, dec infec, Dec osmotic diuresis, dec incidence DKA
52
Nontight DM management
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
How tight control is done
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
Regional considerations dm
Ineffective in area of infection. Concern if autonomic neurop: peripheral neurop, hypotension

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