viernes, 21 de julio de 2017

Patologia tiroidea y anestesia / Thyroid disorders and anesthesia

Julio 19, 2017. No. 2754

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Patricia Zamora Porras
Manejo perioperatorio de pacientes con patología tiroidea y tratamiento crónico con corticoides
Claudio Nazar J, Javier Bastidas E, Maximiliano Zamora H,  Roberto Coloma D, Ricardo Fuentes H
Rev Chil Cir. Vol 68 - Nº 1, Febrero 2016; pág. 87-93

Espectro y prevalencia de trastornos tiroideos en pacientes ingresados en la clínica de anestesiología para cirugía ambulatoria
Spectrum and Prevalence of Thyroid Disorders in Patients Admitted to the Anaesthesiology Outpatient Clinic for Surgery.
Turk J Anaesthesiol Reanim. 2015 Aug;43(4):240-5. doi: 10.5152/TJAR.2015.03206. Epub 2015 Mar 3.
OBJECTIVE: An anaesthetic approach and surgery are important treatment strategies in patients with thyroid dysfunction due to potential complications. We investigated the prevalence of thyroid disorders, the significance of thyroid function tests (TFTs) with respect to anaesthesia in the preoperative period and the need for routine examinations. METHODS: A total of 10,600 patients who were admitted to the anaesthesiology outpatient clinic for surgery were retrospectively screened and enrolled between 2011 and 2013. Evident hypothyroidism was defined as free tetra-iodothyronine (fT4) <0.7 ng dL(-1) and thyroid-stimulating hormone (TSH) >4 mIU mL(-1), and subclinical hypothyroidism was defined as TSH >4 mIU mL(-1) with normal free hormone levels. Evident hyperthyroidism was defined as fT4 >1.7 ng dL(-1) and TSH <0.1 mIU mL(-1), and subclinical hyperthyroidism was defined as TSH <0.1 mIU mL(-1) with normal free hormone levels. Statistical analysis was conducted using the Statistical Package for the Social Sciences (SPSS) version 17.0. Independent samples t-test and one-way analysis of variance were used to compare the difference between groups. RESULTS: Of the participants, 8.5% were found to have hypothyroidism, 2.5% had hyperthyroidism, 3.5% received treatment and 2.5% had their treatment postponed. The likelihood of hypothyroidism was greater among females, and no difference was found between genders with respect to hyperthyroidism. CONCLUSION:
We believe that TFTs are important because of regional factors. However, given the high cost of TFTs and because thyroid dysfunction risk increases with age, we concluded that routine TFTs in young patients with normal physical examination findings are not mandatory.
KEYWORDS: Thyroid function tests; hyperthyroidism; hypothyroidism; iodine
Efecto de las acciones no genómicas de las hormonas tiroideas sobre el efecto anestésico del propofol.
Effect of non-genomic actions of thyroid hormones on the anaesthetic effect of propofol.
Wang Y1, Ma K2, Li LI2, Liu Y2, Si J3, Wan YU4.
Exp Ther Med. 2015 Sep;10(3):959-965. Epub 2015 Jul 7.
Hyperthyroidism is a common disease of the endocrine system and it is known that additional propofol anaesthesia is required during surgery for patients with hyperthyroidism compared with those with normal thyroid function. The aim of the present study was to determine the mechanism through which thyroid hormones (THs) inhibit the effect of propofol anaesthesia. Immunofluorescence techniques were used to verify the difference between the expression quantities of γ-aminobutyric acid type A (GABAA) receptor subunits α2 and β2 in the dorsal root ganglions (DRGs) of rats with hyperthyroidism and those in normal rats. Perforated patch clamp recordings in the whole-cell mode were performed to detect the GABA-activated current in acutely isolated rat DRG neurons from rats with hyperthyroidism and normal rats. This method was also used to evaluate the change in the GABA-activated currents following the pre-perfusion of propofol with and without 3,3',5-L-triiodothyronine (T3). Compared with normal rats, rats with hyperthyroidism expressed same quantities of GABAA receptor α2 and β2 subunits in DRGs. In addition, no difference in GABA-activated currents in the acutely isolated DRG neurons from the two types of rat was observed (P>0.05). T3 inhibits or minimises the augmentation effect of propofol on the GABA-activated currents (P<0.05). The inhibitory effect of T3 on propofol was minimised by increasing the propofol concentration (P<0.05). The inhibitory effect of T3 on the anaesthetic effect of propofol is achieved through the inhibition of the function of GABAA receptors through the non-genomic actions of the THs, rather than by changing the number of GABAA receptors. This inhibitory effect can be mitigated by increasing the propofol concentration. In conclusion, rats with hyperthyroidism require a larger dose of propofol to induce anaesthesia since the non-genomic actions of THs suppress GABA receptors, which in turn inhibits the anaesthetic action of propofol.

XIV Congreso Virtual Mexicano de Anestesiología 2017
Octubre 1-Diciembre 31, 2017
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