RT Book, Section A1 Butterworth IV, John F. A1 Mackey, David C. A1 Wasnick, John D. SR Print(0) ID 1190608222 T1 Anesthesia for Patients with Endocrine Disease T2 Morgan & Mikhail’s Clinical Anesthesiology, 7e YR 2022 FD 2022 PB McGraw-Hill Education PP New York, NY SN 9781260473797 LK accessanesthesiology.mhmedical.com/content.aspx?aid=1190608222 RD 2024/03/29 AB KEY CONCEPTS Diabetic autonomic neuropathy may limit the patient’s ability to compensate (with tachycardia and increased peripheral resistance) for intravascular volume changes and may predispose the patient to cardiovascular instability (eg, postinduction hypotension) and even sudden cardiac death. Temporomandibular joint and cervical spine mobility should be assessed preoperatively in patients with diabetes to reduce the likelihood of unanticipated difficult intubation. Difficult intubation has been reported in as many as 30% of persons with type 1 diabetes. Sulfonylureas and metformin have long half-lives, and many clinicians will discontinue them 24 to 48 h before surgery. They can be started postoperatively when the patient resumes oral intake. Incompletely treated hyperthyroid patients may be chronically hypovolemic and prone to an exaggerated hypotensive response to induction of anesthesia. Clinically hypothyroid patients are more susceptible to the hypotensive effect of anesthetic agents because of diminished cardiac output, blunted baroreceptor reflexes, and decreased intravascular volume. Patients with glucocorticoid deficiency must receive adequate steroid replacement therapy during the perioperative period. In patients with pheochromocytoma, drugs or techniques that indirectly stimulate or promote the release of catecholamines (eg, ephedrine, hypoventilation, bolus doses of ketamine), potentiate the arrhythmic effects of catecholamines (halothane), or consistently release histamine (eg, large doses of atracurium or morphine sulfate) may precipitate hypertension and are best avoided. Obese patients may be difficult to intubate as a result of limited mobility of the temporomandibular and atlantooccipital joints, a narrowed upper airway, and a shortened distance between the mandible and sternal fat pads. The key to perioperative management of patients with carcinoid syndrome is to avoid anesthetic and surgical techniques or agents that could cause the tumor to release vasoactive substances.