Endocrine Disease

Question 1

What is the most worrisome effect of anesthesia on an animal with endocrine disease?

Answer 1

Inappropriate stress response

Require more management and monitoring than a normal patient

Question 2

What are the two phases of the stress response?

Answer 2

First phase- conserve sodium and water to preserve BV

Second phase- healing of damaged tissue

Question 3

What is another name for the second phase of the stress response?

Answer 3

Anabolic phase

Question 4

What can the stress response exacerbate?

Answer 4

Congestive heart failure and acute renal failure

Question 5

What can decrease the stress response?

Answer 5

1. Reduce noxious stimuli
2. Multimodal anesthesia to prevent noxious stimuli
3. Drugs- etomidate and alpha-2 agonists

Question 6

Can exogenous steroids be used to stimulate stress response?

Answer 6

Yes- allows for a normal response to stressful stimuli

Question 7

Which endocrine diseases especially are effected by anesthesia (5).

Answer 7

1. Diabetes mellitus
2. Cushing’s disease
3. Addison’s disease
4. Hyperthyroidism
5. Hypothyroidism

Question 8

What are the clinical signs of DM that are relevant to anesthesia?

Answer 8

• Loss of glucose homeostasis
• Ketoacidosis
• Reduced liver function
• PU/PD
• Weight loss

Question 9

Is it a good idea to put a poorly regulated diabetic under GA?

Answer 9

No

Question 10

What is the major concern with diabetics under anesthesia?

Answer 10

Hypoglycemia and maintenance of normal fluid and electrolyte balance

Question 11

Which drug types are preferable for diabetic patients?

Answer 11

Easily eliminated or antagonized

Question 12

What is the pre-anesthetic protocols for diabetic animals?

Answer 12

• Fasted overnight, BG checked in morning
• Check BG every 30 min under GA
• Maintain BG between 150 and 250 mg/dL

Question 13

What is the protocol for medicating diabetics based on fasted BG?

Answer 13

200- 1/2 usual insulin dose, no dex until BG is below 150

Question 14

What can severe hypoglycemia lead to that will not be apparent until after anesthesia?

Answer 14

Brain damage

Question 15

What anesthetic drugs should be avoided and why?

Answer 15

Alpha-2 agonists- dose dependent transient hypoinsulimemia and hyperglycemia

Question 16

Should you anesthetize a DKA patient?

Answer 16

Not unless absolutely necessary

Question 17

What should be avoided during GA of a DKA patient?

Answer 17

Hypotonic fluids, drugs that rely on hepatic metabolism

Question 18

What should you do for a DKA patient?

Answer 18

Frequently monitor electrolyte and acid-base status, potassium supplementation

Question 19

Should you restrict water in a diabetes insipidus patient?

Answer 19

No

Question 20

What should be monitored with diabetes insipidus patients?

Answer 20

Serum sodium concentrations (keep below 160mEq/L)

Question 21

Should insulinoma patients be minimally fasted prior to surgery?

Answer 21

Yes- must maintain BG over 40

Question 22

What should be monitored especially in insulinoma patients?

Answer 22

• ECG for arrhythmias
• Direct arterial pressure and blood gases
• Check BG every 15-30min

Question 23

What are Cushing;s signs that are relevant to anesthesia?

Answer 23

• Slow tissue healing
• PU/PD
• Hypercoagulability
• Muscle wasting, abdominal enlargment, pulmonary mineralization/thomboembalism (hypoxemia at rest)
• Skin changes
• Lethargy
• Hypertension