Flashcards in Endocrine Disease Deck (23):
What is the most worrisome effect of anesthesia on an animal with endocrine disease?
Inappropriate stress response
Require more management and monitoring than a normal patient
What are the two phases of the stress response?
First phase- conserve sodium and water to preserve BV
Second phase- healing of damaged tissue
What is another name for the second phase of the stress response?
What can the stress response exacerbate?
Congestive heart failure and acute renal failure
What can decrease the stress response?
1. Reduce noxious stimuli
2. Multimodal anesthesia to prevent noxious stimuli
3. Drugs- etomidate and alpha-2 agonists
Can exogenous steroids be used to stimulate stress response?
Yes- allows for a normal response to stressful stimuli
Which endocrine diseases especially are effected by anesthesia (5).
1. Diabetes mellitus
2. Cushing's disease
3. Addison's disease
What are the clinical signs of DM that are relevant to anesthesia?
- Loss of glucose homeostasis
- Reduced liver function
- Weight loss
Is it a good idea to put a poorly regulated diabetic under GA?
What is the major concern with diabetics under anesthesia?
Hypoglycemia and maintenance of normal fluid and electrolyte balance
Which drug types are preferable for diabetic patients?
Easily eliminated or antagonized
What is the pre-anesthetic protocols for diabetic animals?
- Fasted overnight, BG checked in morning
- Check BG every 30 min under GA
- Maintain BG between 150 and 250 mg/dL
What is the protocol for medicating diabetics based on fasted BG?
200- 1/2 usual insulin dose, no dex until BG is below 150
What can severe hypoglycemia lead to that will not be apparent until after anesthesia?
What anesthetic drugs should be avoided and why?
Alpha-2 agonists- dose dependent transient hypoinsulimemia and hyperglycemia
Should you anesthetize a DKA patient?
Not unless absolutely necessary
What should be avoided during GA of a DKA patient?
Hypotonic fluids, drugs that rely on hepatic metabolism
What should you do for a DKA patient?
Frequently monitor electrolyte and acid-base status, potassium supplementation
Should you restrict water in a diabetes insipidus patient?
What should be monitored with diabetes insipidus patients?
Serum sodium concentrations (keep below 160mEq/L)
Should insulinoma patients be minimally fasted prior to surgery?
Yes- must maintain BG over 40
What should be monitored especially in insulinoma patients?
- ECG for arrhythmias
- Direct arterial pressure and blood gases
- Check BG every 15-30min