Dpancuroniumanduse glycopyrrolatewithreversalagent

Info icon This preview shows page 1. Sign up to view the full content.

View Full Document Right Arrow Icon
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: imited time to prepare pt’s for surgery or treat thyrotoxic crisis Radioiodine therapy destroys thyroid tissue Subtotal thyroidectomy when radioiodine is refused or a large goiter is present causing tracheal compression or cosmetic concerns ANESTHETIC MANAGEMENT OF ANESTHETIC MANAGEMENT OF HYPERTHYROIDISM Elective surgery should be deferred until the patient is rendered euthyroid and hyperdynamic state controlled with B­blockers Preop: anxiolytics and evaluation of upper airway (CT scan of the neck) Induction: Thiopental has antithyroid activity (no ketamine) Maintenance: isoflurane or sevoflurane (no halothane) and fentanyl or remi. Attention to body temp, heart rate and eye protection (exothalmos) Muscle relaxation: avoid pancuronium and use glycopyrrolate with reversal agent Treat hypotension with phenylephrine COMPLICATIONS OF SUBTOTAL COMPLICATIONS OF SUBTOTAL THYROIDECTOMY Damage to the recurrent laryngeal nerve when unilateral­>hoarseness, when bilateral­>total airway obstruction Damage to superior laryngeal nerve can lead to aspiration Airway obstruction from tracheomalacia (after extubation) or hematoma (early postop period) Hypoparathyroidism­> hypocalcemia develops 24­72 hours postop (but sometimes 1­3 hours postop)­>laryngeal stridor­>laryngospasm THYROTOXIC CRISIS (THYROID THYROTOXIC CRISIS (THYROID STORM) Medical emergency Typically presents 6­18 hours after surgery Abrupt onset of tachycardia, hyperthermia, agitation, skeletal muscle weakness, congestive heart failure, dehydration and shock due to abrupt release of T4 and T3 into the circulation Precipitated by surgery, infection, trauma, toxemia, DKA TREATMENT OF THYROID TREATMENT OF THYROID STORM Intraveneous cooled crystalloid solutions, acetominophen and cooling blankets Esmolol infusion with goal heart rate <100 Potassium iodide to block release of T4 and T3 Propylthiouracil 100 mg po to inhibit conversion of T4 to T3 Cortisol 100­200 mg IV HYPOTHYROIDISM HYPOTHYROIDISM Prevalence 0.5­0.8% Increased TSH and decreased T4 and T3 Cause is primarily treatment of hyperthyroidism, medically or surgically or Hashimoto’s Thyroiditis Signs and symptoms: lethargy, hypotension, bradycardia, CHF, gastroparesis, hypothermia, hypoventilation, hyponatremia, and poor mentation Treatment with Synthroid ANESTHETIC MANAGEMENT OF ANESTHETIC MANAGEMENT OF HYPOTHYROISM Preop meds titrate and consider supplementa...
View Full Document

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern