TY  - CHAP
M1  - Book, Section
TI  - Anesthetic Considerations for Endocrine Disorders
A1  - Kastner, Galit
A2  - Ellinas, Herodotos
A2  - Matthes, Kai
A2  - Alrayashi, Walid
A2  - Bilge, Aykut
PY  - 2021
T2  - Clinical Pediatric Anesthesiology
AB  - FOCUS  POINTSPreoperative  evaluation  for  elective  surgery  should  include  assessment  of  glycemic  control  (glycohemoglobin  and  serum  blood  sugar),  electrolyte  status,  and  presence  or  absence  of  ketones.  Additional  testing  is  dictated  by  patient  comorbidities.Patients  who  use  glargine  (Lantus®)  should  take  their  full  dose  on  the  evening  prior  to  surgery  or  the  morning  of  surgery  and  omit  their  short-  or  rapid-acting  insulin  dose  on  the  day  of  surgery.Hyperglycemia  impairs  wound  healing,  decreases  chemotaxis  and  phagocytosis,  and  has  been  shown  to  increase  rate  of  surgical  infection.Graves  disease,  an  autoimmune  disease  producing  TSH-receptor  stimulating  antibodies  resulting  in  excess  production  and  release  of  T3  and  T4,  is  the  most  common  cause  of  hyperthyroidism  in  children  and  adolescents.Postoperative  thyroid  surgery  concerns  include  hypocalcemia  from  parathyroid  trauma  causing  muscle  weakness,  respiratory  insufficiency  due  to  vocal  cord  paresis/paralysis,  tracheomalacia  from  a  large  compressive  tumor,  and  obstruction  from  surgical  site  hematoma.The  average  age  of  presentation  of  pheochromocytomas  (PCC)  and  paragangliomas  (PGL)  in  pediatrics  is  11  to  13  years,  with  presentation  varying  from  headaches,  sweating,  flushing,  and  nausea  to  paroxysmal  and  sustained  hypertension.Prior  to  resection  of  PCC  and  PGL,  α-blockade  and  fluid  resuscitation  should  be  initiated  followed  by  β-blockade.  The  order  of  blockade  is  critical  to  prevent  the  unopposed  β  effect  resulting  in  cardiac  dysfunction  and  pulmonary  edema.Post  PCC  and  PGL  resection,  profound  hypotension  may  require  vasopressin  infusion.  
SN  - 
PB  - McGraw Hill
CY  - New York, NY
Y2  - 2024/04/18
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1176458327
ER  -