Anesthesia for Endocrine Emergencies

Peramunage, Dasun; Nikravan, Sara

doi:10.1016/j.anclin.2019.10.006

Cited by 16 publications

(20 citation statements)

References 34 publications

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“…Currently, advanced hemodynamic monitoring is essential and can be performed with both transesophageal Doppler [54], as with pulse contour analysis [55]. The use of Swan-Ganz is only indicated in patients with heart disease secondary to pheochromocytoma/PGL [56]. An alternative in these patients is the use of transesophageal echocardiography [53] since it is very useful to assess blood volume, systolic function and early detection of cardiac complications during hypertensive crises [37].…”

Section: Hemodynamic Monitoringmentioning

confidence: 99%

“…The choice of anesthetic agent is usually less important than achieving a deep anesthetic level that inhibits the cardiovascular response in relation to the effect of catecholamines [37]. However, some general premises are recommended when administering anesthetic drugs [2,37,53,56]:…”

Section: Treatment Of Choice During the Intraoperative Periodmentioning

confidence: 99%

“…On the contrary, during the last period, a lack of catecholamine secretion will induce symptomatic hypotension. [37,53,56,[58][59][60][61] (a) Hypertensive crisis They are usually related to orotracheal intubation and tumor surgical manipulation. They require treatment when SBP is > 200 mmHg for more than 1 min.…”

Section: Treatment Of Choice During the Intraoperative Periodmentioning

confidence: 99%

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Protocol for presurgical and anesthetic management of pheochromocytomas and sympathetic paragangliomas: a multidisciplinary approach

Araujo‐Castro

Pascual‐Corrales

Nattero‐Chávez

et al. 2021

J Endocrinol Invest

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Objective To offer a practical guide for the presurgical and anesthetic management of pheochromocytomas and sympathetic paragangliomas (PGLs). Methods This protocol was based on a comprehensive review of the literature and on our own multidisciplinary team's experience from managing pheochromocytoma and sympathetic PGLs at a referral center. Results Patients with pheochromocytomas and sympathetic paragangliomas (PGLs) may develop potentially life-threatening complications, especially during surgical procedures. A complete biochemical, radiological, genetic, and cardiological assessment is recommended in the preoperative stage as it provides an evaluation of the risk of surgical complications and malignancy, allowing individualization of the presurgical treatment. Treatment with α-blockade and proper volume expansion in the preoperative stage significantly reduces the perioperative morbidity. During surgery, the anesthesiologist should look for a deep anesthetic level that inhibits the cardiovascular effects of catecholamines to minimize the risk of intraoperative complications. Conclusions An optimal presurgical evaluation of pheochromocytomas/ sympathetic PGL requires a multidisciplinary approach, including a complete hormonal, radiological, cardiac, genetic, and functioning evaluation in most cases. A proper preoperative evaluation in combination with strict blood pressure and heart rate control, and blood volume status optimization, will significantly reduce the risk of intraoperative and perioperative complications. In those patients who unfortunately develop intraoperative complications, the role of the anesthesiologist is essential since the selection of the appropriate management has a direct impact on morbimortality reduction. Keywords Pheochromocytoma • Paragangliomas • Presurgical management • Anesthetic treatment • α-blockadeThis article was elaborated by the multidisciplinary adrenal/ paraganglioma team of the Hospital Ramón y Cajal. Madrid (Spain).

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Section: Hemodynamic Monitoringmentioning

confidence: 99%

Section: Treatment Of Choice During the Intraoperative Periodmentioning

confidence: 99%

Section: Treatment Of Choice During the Intraoperative Periodmentioning

confidence: 99%

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Protocol for presurgical and anesthetic management of pheochromocytomas and sympathetic paragangliomas: a multidisciplinary approach

Araujo‐Castro

Pascual‐Corrales

Nattero‐Chávez

et al. 2021

J Endocrinol Invest

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“…Pregnancy complicated with diabetic ketoacidosis (DKA) is an acute metabolic syndrome that can endanger the lives of pregnant women and fetuses. It usually occurs in patients with type 1 (insulin dependent) diabetes [ 2 ]. It is reported in the literature that the incidence rate is about 0.5% and 3%.…”

Section: Introductionmentioning

confidence: 99%

Effect of Continuous Subcutaneous Injection of Insulin Analogues in Pregnant Women with Diabetes Mellitus Complicated with Ketoacidosis

Pan

Wang

Zhao

et al. 2021

Journal of Healthcare Engineering

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Objective. To investigate the clinical effect of continuous subcutaneous injection of insulin analogues in pregnant women with diabetes mellitus complicated with ketoacidosis. Methods. A total of 92 pregnant patients with diabetes mellitus complicated with ketoacidosis from June 2014 to January 2021 were selected. All patients were randomly divided into an observation group and control group according to the method of random number. The control group received intravenous infusion of insulin, and the observation group received continuous subcutaneous infusion of quick-acting insulin analogues. The clinical effects of the two groups were observed. Results. The time needed to control blood glucose <13.8 mmol/L, the amount of insulin needed to control blood glucose <13.8 mmol/L, the time needed to correct DKA, and the amount of insulin needed to correct DKA in the observation group were significantly less than those in the control group ( P < 0.05 ). Compared with the control group, the average occurrence times of hypoglycemia, the length of stay, the total amount of insulin in hospital, and the total amount of insulin used during pregnancy in the observation group were significantly less than those in the control group ( P < 0.05 ). The values of SCr, CRP, BUN, arterial blood gas pH, and adiponectin in the two groups were significantly improved as compared with those before treatment, and the improvement in the observation group was significantly better than that in the control group ( P < 0.05 ). After treatment, the fasting blood glucose, 2-hour postprandial blood glucose, carbon dioxide binding capacity, and glycosylated hemoglobin in the experimental group were significantly better than those in the routine group, and the difference was statistically significant ( P < 0.05 ). Conclusion. Continuous subcutaneous injection of insulin analogues is effective in the treatment of diabetic patients with ketoacidosis, which can effectively improve blood glucose, carbon dioxide binding capacity, and glycosylated hemoglobin and accelerate the negative conversion of urinary ketone body. It is worth popularizing to reduce the occurrence of hypoglycemia and the dose of insulin and shorten the time of hospitalization.

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“…These may include the preoperative use of anxiolytics and avoidance of light planes of anesthesia. Also recommended is avoidance of medications that can precipitate histamine release, and a focus on maintaining adequate preload [ 2 , 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

When Zebras Collide: A Case of Synchronous Wolff-Parkinson-White Syndrome and Pheochromocytoma

2021

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Patient: Male, 36-year-old Final Diagnosis: Pheochromocytoma Symptoms: Chest discomfort • headache • shortness of breath • symptomatic tachyarrhythmia Medication: — Clinical Procedure: — Specialty: General and Internal Medicine Objective: Rare coexistence of disease or pathology Background: Pheochromocytoma is a rare catecholamine-secreting tumor arising from chromaffin cells of the adrenal medulla. Wolff-Parkinson-White (WPW) pattern is a rare congenital cardiac conduction disorder in which 1 or more accessory pathways connects the atria and ventricles, bypassing the atrioventricular (AV) node. Patients with this type of accessory pathway who also experience pre-excitation evoked arrhythmias have what is termed WPW syndrome. Here, we present a patient with a WPW pattern who underwent surgical resection of a pheochromocytoma, review considerations relating to the perioperative management, and briefly summarize the hormonal effects of pheochromocytoma in a patient with a WPW accessory pathway. Case Report: A man in his early 30’s with a history of hypertension developed shortness of breath with palpitations, was noted to have delta waves on electrocardiogram (ECG), and was given a diagnosis of WPW syndrome. Six years later, he developed headache, chest pain, and flank discomfort in addition to his daily palpitations and shortness of breath. Plasma catecholamine levels were measured and found to be elevated, and imaging studies noted the presence of a large right-sided adrenal mass, consistent with a pheochromocytoma. A decision was made to proceed with a laparoscopic right adrenalectomy, which was successful and uneventful. Through the 30-day postoperative period, he reported no further episodes of symptomatic palpitations for the first time in several years. Conclusions: To the best of our knowledge, this is only the fourth case in the literature describing pheochromocytoma with co-existing WPW syndrome. In our case, resection of the pheochromocytoma ameliorated the patient’s chronic WPW-related tachyarrhythmia.

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Anesthesia for Endocrine Emergencies

Cited by 16 publications

References 34 publications

Protocol for presurgical and anesthetic management of pheochromocytomas and sympathetic paragangliomas: a multidisciplinary approach

Protocol for presurgical and anesthetic management of pheochromocytomas and sympathetic paragangliomas: a multidisciplinary approach

Effect of Continuous Subcutaneous Injection of Insulin Analogues in Pregnant Women with Diabetes Mellitus Complicated with Ketoacidosis

When Zebras Collide: A Case of Synchronous Wolff-Parkinson-White Syndrome and Pheochromocytoma

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