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Part 4. Managing Anesthesia Care
Section E. Specialty Areas of Anesthetic Practice
Chapter 59. Endocrine Surgery and Intraoperative Management of Endocrine Conditions
Robert A. Peterfreund, MD, PhD, and Stephanie L. Lee, MD, PhD
1. Endocrine diseases are common comorbid conditions in surgical patients.
2. The patient's type of diabetes mellitus must be known and the differing therapies of types 1 and 2 appreciated.
3. Frequent monitoring of glucose levels is a mainstay in the management of the diabetic patient undergoing anesthesia and surgery.
4. Hypothyroid patients may exhibit sensitivity to sedative and hypnotic drugs used perioperatively. Hemodynamic instability should be anticipated.
5. Hyperthyroid patients may exhibit hemodynamic instability and are at particular risk for tachydysrhythmias and metabolic decompensation.
6. The airway is a key consideration in patients undergoing thyroid surgery.
7. Pheochromocytoma patients require careful preoperative preparation, and plans must be made to manage hemodynamic extremes during surgery.
8. Glucocorticoid deficiency in patients at risk for adrenal suppression should be anticipated.
9. The implications of growth hormone excess (acromegaly) and adrenal steroid excess (Cushing disease) should be considered when preparing patients for pituitary surgery.
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