Anesthesia

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Hypothyroidism

Tue, 12/25/2007 - 11:11 — oxygen
Hypothyroidism Listen to Audio endocrine1.jpg Clinical causes Clinical manifestations Diagnosis Treatment Preoperative management Intraoperative management Postoperative management Clinical causes: -Hashimotos thyroiditis -iodine deficiency -radioactive iodine -antithyroid medications -thyroidectomy -secondary hypothyroidism Clinical manifestations -weight gain -cold intolerance -muscle fatigue -lethargy -constipation -reflex decreased (hyporeflexia) -depression Diagnosis: Primary hypothyroidism: -decreased T3 -decreased T4 -increased TSH Secondary hypothyroidism: -decreased T3 -decreased T4 -decreased TSH Treatment: Oral replacement: -physiological effect within few days -clinical improvement within several weeks Myxedema/emergency: -loading dose: levothyroxine 300 - 500mg -maintenence doses: ex. levothyroxine 50 mg q day Preoperative management: Elective surgery: -thyroid hormone level should be therapeutic Emergency surgery: give thyroid hormone prior to procedure in patients with: -uncorrected severe hypothyroidism T4< 1mg/dL -myxedema coma Premedication: -may not be required due to the sedative nature of the disease (lethargy, depression) -may be more prone to opiod induced respiratory depression Intraoperative management: induction: ketamine may be considered induction agent of choice Airway: may be difficult intubation due to large tongue CNS: same MAC requirements CVS: senstive to cardiodepressant effects of volatile anesthetics due to: -decreased intravascular volume therefore decreased preload -blunted baroreceptor response theferefore decreased HR -overall decreased cardiac output Other possible intraoperative complications: -hypoglycemia -hyponatremia -hypothermia -large tongue for difficult ventilation/intubation Postoperative management May have delayed emergence/recovery from GA due to: -hypothermia -respiratory depression -delayed/slowed drug biotransformation *therefore may require prolonged mechanical ventilation *ketorolac may be preferred to opiod analgesia due to less risk of drug induced respiratory depression

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