Anestesia e hipertiroidismo / Anesthesia and hyperthyroidism

Julio 20, 2017. No. 2755

La tiroidectomía total como método de elección en el tratamiento de la enfermedad de Graves - análisis de 1432 pacientes. Total thyroidectomy as a method of choice in the treatment of Graves' disease - analysis of 1432 patients. Bojic T1, Paunovic I2,3, Diklic A4,5, Zivaljevic V6,7, Zoric G8, Kalezic N9,10, Sabljak V11,12, Slijepcevic N13, Tausanovic K14, Djordjevic N15,16, Budjevac D17, Djordjevic L18, Karanikolic A19,20. BMC Surg. 2015 Apr 9;15:39. doi: 10.1186/s12893-015-0023-3. Abstract BACKGROUND: Graves' disease represents an autoimmune disease of the thyroid gland where surgery has an important role in its treatment. The aim of our paper was to analyze the results of surgical treatment, the frequency of microcarcinoma and carcinoma, as well as to compare surgical complications in relation to the various types of operations performed for Graves' disease. METHODS: We analysed 1432 patients (221 male and 1211 female) who underwent surgery for Graves' disease at the Centre for Endocrine Surgery in Belgrade during 15 years (1996-2010). Average age was 34.8 years. Frequency of surgical complications within the groups was analyzed with nonparametric Fisher's test. RESULTS: Total thyroidectomy (TT) was performed in 974 (68%) patients, and Dunhill operation (D) in 221 (15.4). Carcinoma of thyroid gland was found in 146 patients (10.2%), of which 129 (9%) were a microcarcinoma. Complication rates were higher in the TT group, where there were 31 (3.2%) patients with permanent hypoparathyroidism, 9 (0.9%) patients with unilateral recurrent nerve paralysis and 10 (1.0%) patients with postoperative bleeding. Combined complications, such as permanent hypoparathyroidism with bleeding were more common in the D group where there were 2 patients (0,9%), while unilateral recurrent nerve paralysis with bleeding was more common in the TT group where there were 3 cases (0,3%). CONCLUSIONS: Frequency of complications were not significantly statistically different in relation to the type of surgical procedure. Total thyroidectomy represents a safe and efficient method for treating patients with Graves' disease, and it is not followed by a greater frequency of complications in relation to less extensive procedures. PDF  Anestesia y cirugía tiroidea: los interminables desafíos. Anesthesia and thyroid surgery: The never ending challenges. Bajwa SJ1, Sehgal V. Indian J Endocrinol Metab. 2013 Mar;17(2):228-34. doi: 10.4103/2230-8210.109671. Abstract Thyroidectomy is the most common endocrine surgical procedure being carried out throughout the world. Besides, many patients who have deranged thyroid physiology, namely hyperthyroidism and hypothyroidism, have to undergo various elective and emergency surgical procedures at some stage of their life. The attending anesthesiologist has to face numerous daunting tasks while administering anesthesia to such patients. The challenging scenarios can be encountered at any stage, be it preoperative, intra-op or postoperative period. Preoperatively, deranged thyroid physiology warrants optimal preparation, while anticipated difficult airway due to enlarged thyroid gland further adds to the anesthetic challenges. Cardiac complications are equally challenging as also the presence of various co-morbidities which make the task of anesthesiologist extremely difficult. Thyroid storm can occur during intra-op and post-op period in inadequately prepared surgical patients. Postoperatively, numerous complications can develop that include hemorrhage, laryngeal edema, nerve palsies, tracheomalacia, hypocalcemic tetany, pneumothorax, etc., The present review aims at an in-depth analysis of potential risk factors and challenges during administration of anesthesia and possible complications in patients with thyroid disease. KEYWORDS: Airway management; carbimazole; propanolol; thyroid; thyroidectomy; thyroxin; tracheomalacia PDF Anestesia para timectomia en un paciente con miastenia gravis e hipertiroidismo no controlado Anesthetic management of patient with myasthenia gravis and uncontrolled hyperthyroidism for thymectomy. Datt V1, Tempe DK, Singh B, Tomar AS, Banerjee A, Dutta D, Bhandari H. Ann Card Anaesth. 2010 Jan-Apr;13(1):49-52. doi: 10.4103/0971-9784.58835.Abstract The relationship between myasthenia gravis (MG) and other autoimmune disorders like hyperthyroidism is well known. It may manifest earlier, concurrently or after the appearance of MG. The effect of treatment of hyperthyroidism on the control of MG is variable. There may be resolution or conversely, deterioration of the symptoms also. We present a patient who was diagnosed to be hyperthyroid two and half years before the appearance of myasthenic symptoms. Pharmacotherapy for three months neither improved the myasthenic symptoms nor the thyroid function tests. Thymectomy resulted in control of MG as well as hyperthyroidism. In conclusion, effective control of hyperthyroidism in the presence of MG may be difficult. The authors opine that careful peri-operative management of thymectomy is possible in a hyperthyroid state. PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Anestesia, diabetes y corazon / Anesthesia, diabetes and hearth

Julio 10, 2017. No. 2745

Diabetes, isquemia perioperatoria y anestésicos volátiles: consecuencias de trastornos en el metabolismo del sustrato miocárdico. Diabetes, perioperative ischaemia and volatile anaesthetics: consequences of derangements in myocardial substrate metabolism. van den Brom CE1, Bulte CS, Loer SA, Bouwman RA, Boer C. Author information Cardiovasc Diabetol. 2013 Mar 4;12:42. doi: 10.1186/1475-2840-12-42. Abstract Volatile anaesthetics exert protective effects on the heart against perioperative ischaemic injury. However, there is growing evidence that these cardioprotective properties are reduced in case of type 2 diabetes mellitus. A strong predictor of postoperative cardiac function is myocardial substrate metabolism. In the type 2 diabetic heart, substrate metabolism is shifted from glucose utilisation to fatty acid oxidation, resulting in metabolic inflexibility and cardiac dysfunction. The ischaemic heart also loses its metabolic flexibility and can switch to glucose or fatty acid oxidation as its preferential state, which may deteriorate cardiac function even further in case of type 2 diabetes mellitus.Recent experimental studies suggest that the cardioprotective properties of volatile anaesthetics partly rely on changing myocardial substrate metabolism. Interventions that target at restoration of metabolic derangements, like lifestyle and pharmacological interventions, may therefore be an interesting candidate to reduce perioperative complications. This review will focus on the current knowledge regarding myocardial substrate metabolism during volatile anaesthesia in the obese and type 2 diabetic heart during perioperative ischaemia. PDF El preacondicionamiento inducido por isoflurano es atenuado por la diabetes. Isoflurane-induced preconditioning is attenuated by diabetes. Tanaka K1, Kehl F, Gu W, Krolikowski JG, Pagel PS, Warltier DC, Kersten JR. Am J Physiol Heart Circ Physiol. 2002 Jun;282(6):H2018-23. Abstract Volatile anesthetics stimulate, but hyperglycemia attenuates, the activity of mitochondrial ATP-regulated K(+) channels. We tested the hypothesis that diabetes mellitus interferes with isoflurane-induced preconditioning. Acutely instrumented, barbiturate-anesthetized dogs were randomly assigned to receive 0, 0.32, or 0.64% end-tidal concentrations of isoflurane in the absence or presence of diabetes (3 wk after administration of alloxan and streptozotocin) in six experimental groups. All dogs were subjected to a 60-min left anterior descending coronary artery occlusion followed by 3 h of reperfusion. Myocardial infarct size (triphenyltetrazolium staining) was 29 +/- 3% (n = 8) of the left ventricular area at risk in control experiments. Isoflurane reduced infarct size (15 +/- 2 and 13 +/- 1% during 0.32 and 0.64% concentrations; n = 8 and 7 dogs, respectively). Diabetes alone did not alter infarct size (30 +/- 3%; n = 8) but blocked the protective effects of 0.32% (27 +/- 2%; n = 7) and not 0.64% isoflurane (18 +/- 3%; n = 7). Infarct size was directly related to blood glucose concentrations in diabetic dogs, but this relationship was abolished by higher concentrations of isoflurane. The results indicate that blood glucose and end-tidal isoflurane concentrations are important determinants of infarct size during anesthetic-induced preconditioning. PDF  Anestésicos como cardioprotectores: traducibilidad y mecanismo. Anaesthetics as cardioprotectants: translatability and mechanism. Kikuchi C1, Dosenovic S, Bienengraeber M. Br J Pharmacol. 2015 Apr;172(8):2051-61. doi: 10.1111/bph.12981. Epub 2015 Jan 12. Abstract The pharmacological conditioning of the heart with anaesthetics, such as volatile anaesthetics or opioids, is a phenomenon whereby a transient exposure to an anaesthetic agent protects the heart from the harmful consequences of myocardial ischaemia and reperfusion injury. The cellular and molecular mechanisms of anaesthetic conditioning appear largely to mimic those of ischaemic pre- and post-conditioning. Progress has been made on the understanding of the underlying mechanisms although the order of events and the specific targets of anaesthetics that trigger protection are not always clear. In the laboratory, the protection afforded by certain anaesthetics against cardiac ischaemia and reperfusion injury is powerful and reproducible but this has not necessarily translated into similarly robust clinical benefits. Indeed, clinical studies and meta-analyses delivered variable results when comparing in the laboratory setting protective and non-protective anaesthetics. Reasons for this include underlying conditions such as age, obesity and diabetes. Animal models for disease or ageing, human cardiomyocytes derived from stem cells of patients and further clinical studies are employed to better understand the underlying causes that prevent a more robust protection in patients PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Encuentro Internacional de Manejo de la Vía Aérea Bariloche. Argentina. Nov 30-Dic 2, 20l7 Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org