50 Anesthesia for Patients with Endocrine Disease

Diabetes mellitus

Loss of glucose homeostasis, ketoacidosis, reduced liver function, PU/PD and weight loss are all clinical signs relevant to anesthesia for WHAT disease?

FALSE: should be regulated before an elective surgery

TRUE OR FALSE: patients with diabetes mellitus do not have to be regulated for an elective surgery

Prevent hypoglycemia

What is the goal of having a diabetes mellitus patient under anesthesia?

So the patient can recovery quickly and resume its normal feeding schedule

Why should you use drugs that are quickly eliminated or can be antagonized with diabetes mellitus anesthesia?

a. not give insulin and start 2.5-5% dextrose infusion

Insulin administration the morning of surgery for diabetic patients depends on blood glucose levels. If a patient has under 100 mg/dL, you should:

a. not give insulin and start 2.5-5% dextrose infusion

b. give 1/4 dose usual insulin and start 2.5% dextrose

c. give 1/2 dose usual insulin

d. give "regular insulin" or full amount

b. give 1/4 dose usual insulin and start 2.5% dextrose

Insulin administration the morning of surgery for diabetic patients depends on blood glucose levels. If a patient is 100-200 mg/dL, you should:

a. not give insulin and start 2.5-5% dextrose infusion

b. give 1/4 dose usual insulin and start 2.5% dextrose

c. give 1/2 dose usual insulin

d. give "regular insulin" or full amount

c. give 1/2 dose usual insulin

Insulin administration the morning of surgery for diabetic patients depends on blood glucose levels. If a patient reads over 200 mg/dL, you should:

a. not give insulin and start 2.5-5% dextrose infusion

b. give 1/4 dose usual insulin and start 2.5% dextrose

c. give 1/2 dose usual insulin

d. give "regular insulin" or full amount

d. give "regular insulin" or full amount

Insulin administration the morning of surgery for diabetic patients depends on blood glucose levels. If a patient reads over 300 mg/dL, you should:

a. not give insulin and start 2.5-5% dextrose infusion

b. give 1/4 dose usual insulin and start 2.5% dextrose

c. give 1/2 dose usual insulin

d. give "regular insulin" or full amount

Every 30 minutes (then periodically in recovery, every 30-90 mins, until patient is eating)

How often should you measure blood glucose under anesthesia for a diabetes mellitus patient?

Between 150 and 200 mg/dL

What do you want to maintain the blood glucose at under anesthesia for diabetic patients?

Brain damage

What can happen if you let a patient get severely hypoglycemic under anesthesia?

Hyperadrenocorticism (Cushings)

This is secretion of excess glucocorticoids by the adrenal cortex caused by neoplasia or a pituitary tumor inc. ACTH

Hyperadrenocorticism (Cushings)

PU/PD, dehydration/hypovolemia, pulmonary thromboembolism, muscle wasting, lethargy, hypertension, and slow tissue healing + skin changes are all clinical signs relevant to anesthesia for WHAT disease?

Preoxygenate, ventilatory support and position carefully

How can you avoid hypoxemia in a hyperadrenocorticism patient under anesthesia?

Skin changes and bruising

What can make placing an IVC difficult with hyperadrenocorticism patients?

Hypoadrenocorticism (Addisons)

This is the disease which is caused by insufficient production of glucocorticoids, mineralocorticoids, or both, meaning the animal has an inappropriate stress response to surgery

Hypoadrenocorticism (Addisons)

Bradycardia, hypothermia, dehydration, PU/PD, anorexia, weight loss, vomiting, diarrhea, and syncope are all clinical signs relevant to anesthesia for WHAT disease?

Addisons

Young to middle aged females are the common signalment for typical Cushings or Addisons patients

Hyperkalemia and hyponatremia for Addison's

note: remember hypokalemia with hypernatremia is HYPERALDOSTERONISM NOT ADDISONS

What electrolyte abnormalities do you have to be aware of for anesthesia of Addison's (Hypoadrenocorticism) patients?

SHOULD: LRS

SHOULD NOT: 0.9% saline

You need to carefully consider IVF therapy for Addison's (Hypoadrenocorticism) patients. What should you and should you NOT use?

Exogenous glucocorticoids

What can you give Addison's (Hypoadrenocorticism) patients to prevent adrenal crisis and circulatory collapse under anesthesia?

POST RECOVERY MINOR: back to normal maintenance regimen

POST RECOVERY MAJOR: dexamethasone OR prednisone for 3 days THEN back to normal maintenance regimen at day 4

For major AND minor surgery on patients with Addison's (Hypoadrenocorticism), you give Dexamethasone pre-op and immediately post-op. What is the difference for post-recovery between a major and minor surgery?

Hyperthyroidism

Increased metabolic rate, decreased muscle mass, inc. potential for HCM, renal failure, and hyperactivity are all clinical signs relevant to anesthesia for WHAT disease?

It makes them prone to hypoxemia, increased CO2 production, and hypoglycemia

Why is increased metabolic rate in hyperthyroidism a problem for anesthesia?

Respiratory obstruction and difficult to intubate

Hyperthyroidism may cause increased mechanical pressure on the trachea. Why does this matter for anesthesia?

iHYPOcalcemia and hyperphosphatemia

What CBC/chem changes may occur with hyperthyroidism that are relevant for anesthesia?

Inc. HR, BP, and temp, cardiac dysrhythmias, shock

Thyroid storms may occur under anesthesia in hyperthyroidism patients. This excessive thyroid hormone production is precipitated by catecholamine release which can cause WHAT KINDS of issues for anesthesia?

Atenolol

If tachycardia and arrhythmia cannot be controlled in hyperthyroid patients before surgery, what should be given starting 3-5 days prior

Opioids

What are a mainstay medication for analgesia and anesthesia dose reduction in hyperthyroid patients

Acepromazine

What is a very useful anesthetic for hyperthyroid patients?

AVOID atropine and glycopyrrolate, use ketamine ONLY in LOW DOSES

What should be AVOIDED in hyperthyroid patients? What medications?

Calcium

What do you need to administer to cats following a bilateral thyroidiectomy for 5 days post op?

Hypothyroidism

Reduced cardiovascular capacity, obesity, lethargy, dec. metabolic rate and drug excretion, dec. heat production, and mild anemia are all clinical signs relevant to anesthesia for WHAT disease?

Thyroxine

For an elective surgical procedure, what should you stabilize a hypothyroid patient with for 1-2 weeks before?

They often have slow recovery with hypothermia = provide active warming sources

What do you need to remember about anesthesia and hypothyroid patient body temps?

Hypoventilation can occur due to muscle weakness and obesity

What do you need to remember about anesthesia and hypothyroid patient ventilation?