1 / 9

Thyroidectomy in Patient with Hypertension

Case 65. Thyroidectomy in Patient with Hypertension. A 38 year old man is scheduled for thyroid goiter surgery. He has a history of hypertension and has been on metaproterenol and captopril. BP: 180/110, PR: 80/min ECG no specific ST-T changes. Preoperative Evaluation.

Albert_Lan
Download Presentation

Thyroidectomy in Patient with Hypertension

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Case 65 Thyroidectomy in Patient with Hypertension A 38 year old man is scheduled for thyroid goiter surgery. He has a history of hypertension and has been on metaproterenol and captopril. BP: 180/110, PR: 80/min ECG no specific ST-T changes.

  2. Preoperative Evaluation • History: symptoms of hyperthyroidism such as anxiety, fatigue, heat intolerance, diarrhea, dyspnea, and palpitations • PE: BP, T, HR(tachycardia?), rhythym(tachydysrhythmias?), goiter, Thyrotoxic myopathy(proximal weakness), exophthalmos • PMH: Hypertension, asthma

  3. Preop/Labs/Tests • TSH, T3, T4 • Is patient euthyroid? • CBC, LFT, ECG • CT neck, flow-volume loops • Airway obstruction?

  4. Preop Medication • Clonidine • Will blunt sympathetic nervous response • Midazolam • No anticholinergics • Interfere with heat regulation and contribute to increased heart rate

  5. Induction Anesthesia/Muscle Relaxants • Thiopental • Thiourea structure with antithyroid activity • NDNM or succinyl choline

  6. Alternate Intubation Plan • Awake intubation with fentanyl

  7. Maintenance Anesthetic Agents • Sevoflurane/nitrous oxide mixture • Suppresses sympathetic nervous system • Possibly avoid Desflurane • Large bolus can cause transient increase in sympathetic activity • Alternate is short-acting opioid/nitrous oxide • However, does not reliably suppress sympathetic nervous system.

  8. Intraoperative Medical Care • Thyroid storm, which mimics malignant hyperthermia, can consist of hyperthermia, tachycardia, CHF, low intravascular volume, and shock • Chilled crystalloid infusion • Continuous esmolol infusion • Propylthiouracil, methimazole, NaI • If persistent hypotension, then Dexamethasone • Inhibits T4 to T3 conversion • No aspirin • Increases level of free T4 • Elevated BP • Esmolol

  9. Early Postoperative Care • Thyroid storm usually occurs 6-18 hrs post-op • Other Complication: • Recurrent laryngeal nerve injury • Hematoma • Tracheomalacia • Hypoparathyroidism • Superior laryngeal nerve injury • Pain management - PCA

More Related