Dpancuroniumanduse glycopyrrolatewithreversalagent

Info iconThis 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

This note was uploaded on 12/16/2011 for the course BIOLOGY 101 taught by Professor Mr.wallace during the Fall '11 term at Montgomery College.

Ask a homework question - tutors are online