Anesthesia For Endocrine

Front 1

Name differential dx in someone presenting with headache, HTN, elevated RR, BP, HR

Back 1

Pheo, hypo/hyper glycemia, MI, thyroid storm, HTN, stroke

Front 2

What is the normal percent of circulating epi to norep?

Back 2

80% and 20%

Front 3

What is the ratio of circulating catecholamines in pheochromocytomas?

Back 3

9:1, more norepi

Front 4

Name the symptom triad found in pheo

Back 4

headache, diaphoresis, tachycardia

Front 5

What is the conclusive (but subjective) test for pheo

Back 5

elevated plasma norepi

Front 6

What is another test for pheo?

Back 6

24 hr urine for metanephrines. 95% of pheo have increased levels. If elevated, test for free catecholamines. If all 3 negative, - pheo.

Front 7

What drug can be given to test for pheo?

Back 7

Clonidine bc of A2 antagonism. If BP doesn't go down= + pheo
Also phentolamine (regitan)

Front 8

What is MIBG scintography?

Back 8

test where dye will concentrate in cromaffin cells bc of similarity to NE. 85% sensitive, 97% specific

Front 9

What drug must be stopped 1-2 weeks before pheo removal?

Back 9

MAOI- blocks breakdown of dopamine and norepi.

Front 10

Name minimul preoperative criteria for pheo surgery

Back 10

BP <160/90 for 48 hrs before surgery, no ST changes for 1 wk, no more than 1 PVC/5 mins

Front 11

What to avoid during pheo surgery

Back 11

histamine releasing drugs, possibly Des, pancuronium, droperidol (toursades) ketamine, narcan, succ contraversial d/t catecholamine release

Front 12

Name possible anesthetic plan for pt with pheo surg

Back 12

GETA + epidural, preoperative benzos, deep induction for DL, succ contraversial, use of nitroprusside, narcotics.

Front 13

What do you anticipate post tumor removal?

Back 13

hypo/hyperglycemia, hypotension treated with direct A1 agonist, HTN if residual catecholamines

Front 14

Name S/S of Cushing's disease

Back 14

Truncal obesity, thin extremities, buffalo hump, osteopenia, hyperglycemia, HTN from fluid overload, emotional liability, increased risk of infection

Front 15

Name S/S of Addison's

Back 15

primary adrenal insufficiency- skeletal muscle weakness, hypoglycemia, hemoconcentration, wt loss, hypotension, dehydration, needs steroid dose before surgery

Front 16

Characteristics of T3 and T4

Back 16

T3- more potent, in peripheral tissues
T4- more in circulation overall, less potent

Front 17

Drugs used in hyperthyroidism

Back 17

Thioamindes to inhibit thyroid peroxidase, PTU, methimazole. Iodides inhibit production and release of thyroid hormone. T3 and T4 because of negative feedback mechanism

Front 18

What is the role of beta blockade in hyperthyroidism?

Back 18

Inhibits peripheral conversion of T4 to T3 and decreases tachycardia associated with increased SNS activity

Front 19

What is the role of corticosteroids in hyperthyroidism?

Back 19

Inhibits TSH and peripheral conversion of T4 to T3

Front 20

Name intraoperative considerations during thyroidectomy

Back 20

thiopental (dose dependent antithyroid activity), propofol, etomidate, (no ketamine), positioning, des contraversial, N20 ok, DL can cause ball valve obstruction

Front 21

Name S/S of thyroid storm

Back 21

hyperthemia, tachycardia, tachydysrythmias, altered mentation (part of differential)

Front 22

Name causes of thyroid storm

Back 22

6-18 hrs postop. Precipitating factors- infection, surgery, DKA, CHF, pregnancy, extreme stress.

Front 23

What disease is thyroid storm linked to?

Back 23

Non-euthyroid preoperative Grave's disease

Front 24

Name differential dx of MH

Back 24

hyperthermia, tachycardia, HTN, hypercarbia, elevated CO2, Masseter spasm

Front 25

Name differential dx of thyroid storm

Back 25

hyperthermia, tachycardia, tachydysrythmias, HTN, altered mentation

Front 26

Name differential dx of pheo

Back 26

Tachycardia, paroxysmal HTN, headaches

Front 27

Why is ASA dangerous in thyroid storm?

Back 27

Displaces thyroid hormone from protein and increases circulating free levels

Front 28

Name postoperative complications of thyroidectomy

Back 28

RLN damage, acute hypoglycemia (parathyroid removal), pneumo, hematoma (airway compression, especially in tracheomalacia)

Front 29

Name S/S hypothyroidism

Back 29

lethargy, cold intolerance, decreased CO and HR, peripheral vasoconstriction, decreased platelet adhesion, anemia, impaired renal concentration, adrenal cortex suppression

Front 30

Preop concerns of hypothyroidism

Back 30

low cardiac reserve and stress response, possible CV collapse with CHF, down regulation of baroreceptors, chronic hypovolemia, more sensitive to hypotension causing meds, less response to hypoxia and hypercapnea, delayed gastric empyting

Front 31

anesthetic concerns of hypothyroidism

Back 31

anemia, hypothermia, low dose induction agent with no change in MAC, delayed emergence from low drug metabolism. Respond weill to direct acting agents when treating hypotension

Front 32

Myxedema coma

Back 32

Extreme hypothyroidism, impaired mentation, hypoventilation, hyponatremia, CHF, hypoglycemia, may have bowel obstruction. 80% mortality

Front 33

Hyperparathyroidism

Back 33

adenoma, CA, hyperplasia of parathyroid that causes hypersecretion. Hypercalcemia= kidney stones, confusion, HTN, arrythmias

Front 34

What is amitiza?

Back 34

prokinetic with no anticholinergic effects

Front 35

Transphenoidal Adenohypophysectomy

Back 35

Possiblity of DI,steroid prep, Rae tube, mouth pack, avoid hyperventilation, mannitol, and N20, awake extubation