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Anaesthesiology
Endocrine Function
Built from Barash Clinical Anesthesia, 9th Edition
What’s inside
9 sections · 198 slides
Overview
- Scope of the topic
- Key messages of the topic
Thyroid Gland
- Function of thyroid hormone
- Stages of thyroid hormone biosynthesis
- Reading the hormone synthesis diagram
- Iodide handling and control of thyroid hormone release
- Hypothalamic-pituitary-thyroid feedback loop
- Production, half-life and protein binding of thyroid hormone
- Normal concentrations and cardiovascular actions
- Thyroid-stimulating hormone as the first test
- Serum thyroxine assay and its pitfalls
- Serum triiodothyronine measurement
- Pattern of thyroid function tests in different states
- Interpreting the thyroid test pattern
- Tests for thyroid hormone binding
- Radioactive iodine uptake, and hot versus cold nodules
- Definition and commonest cause of hyperthyroidism
- Causes of hyperthyroidism
- Thyroiditis and other causes of hyperthyroidism
- General features of hyperthyroidism
- Cardiovascular features, and hyperthyroidism in older patients
- Antithyroid drugs and inorganic iodide
- Beta-blockade and the combined preoperative regimen
- Glucocorticoids and radioiodine therapy
- Anaesthetic conduct in the hyperthyroid patient
- Thyroid storm
- Management of thyroid storm
- Principles of treating thyroid storm
- Indications and technique for thyroid surgery
- Airway risk and approach in goitre surgery
- Complications after thyroidectomy
- Hypocalcaemia after thyroid surgery
- Recurrent laryngeal nerve injury patterns
- Nerve monitoring and extubation after thyroid surgery
- Definition and frequency of hypothyroidism
- Causes of hypothyroidism
- General features of hypothyroidism
- Cardiovascular features of hypothyroidism
- Treatment and the question of delaying surgery
- Preoperative decision in hypothyroidism
- Severe hypothyroidism and coronary disease
- Myxedema coma and its treatment
- Management of myxedema
Parathyroid Glands
- Albumin, pH and the roles of free calcium
- Parathyroid hormone and vitamin D metabolism
- Actions of parathyroid hormone and calcium balance
- Control of parathyroid hormone secretion
- Primary hyperparathyroidism and its course in pregnancy
- Clinical features of hypercalcaemia
- Diagnosing hyperparathyroidism and hypercalcaemia of malignancy
- Primary, secondary and tertiary hyperparathyroidism
- Choosing surgery and preparing for it
- Correcting low phosphate in hypercalcaemia
- Drugs used to lower serum calcium
- Anaesthetic considerations in hyperparathyroidism
- Complications after parathyroid surgery
- Clinical features of hypocalcaemia
- Cardiovascular features of hypocalcaemia
- Treatment of hypoparathyroidism
Adrenal Cortex
- Stress rhythm and the metabolic actions of cortisol
- Aldosterone and the renin-angiotensin system
- Volume and potassium feedback loops controlling aldosterone
- Renin-angiotensin-aldosterone cascade
- Cushing syndrome and its causes
- Signs and symptoms of Cushing syndrome
- Preparation and steroid cover for adrenal surgery
- Mineralocorticoid excess and its diagnosis
- Preparing the patient with primary aldosteronism
- Hidden adrenal suppression and the Addisonian picture
- Recognising and testing for adrenal insufficiency
- Maintenance glucocorticoid and mineralocorticoid replacement
- Management of acute adrenal insufficiency
- Immediate treatment of acute adrenal insufficiency
- Perioperative cortisol output and anaesthetic technique
- Plasma cortisol after induction in steroid-treated and control patients
- Reading the perioperative cortisol curve
- Who is at risk of adrenal suppression?
- Steroid replacement options by degree of surgical stress
- Perioperative steroid cover by surgical stress
- Evidence on supplementation and choice of preparation
- Glucocorticoid preparations
- Mineralocorticoid insufficiency
Adrenal Medulla and Pheochromocytoma
- Nature of the adrenal medulla
- Synthesis and metabolism of endogenous catecholamines
- Catecholamine synthesis, storage and release
- Catabolism of norepinephrine and epinephrine
- Breakdown of circulating catecholamines
- Central control of sympathetic outflow
- Location, spread and familial pheochromocytoma
- Presentation and cardiomyopathy in pheochromocytoma
- Biochemical diagnosis of pheochromocytoma
- Alpha-blockade before pheochromocytoma surgery
- Drugs used in the management of pheochromocytoma
- Alpha-blocking drugs for pheochromocytoma
- Beta-blockade, labetalol and alpha-methyltyrosine
- Induction and surgical approach for pheochromocytoma
- Treating the intraoperative hypertensive crisis
- Haemodynamic sequence around tumour removal
- Haemodynamics and recovery after tumour removal
Diabetes Mellitus
- Diagnostic glucose thresholds
- Classification and type 1 diabetes
- Type 2 diabetes and the overlap between types
- Diabetes from pancreatic and hormonal causes
- Drug-related and gestational diabetes
- Triggers of insulin release and where glucose goes
- Insulin, fuel storage and ketone formation
- Glucagon, the opposing hormone
- Metabolic stress response and hyperglycaemia
- Diagnosis by HbA1c and the A1c-glucose relationship
- Correlation of haemoglobin A1c with average glucose
- Criteria for the diagnosis of diabetes
- Treatment targets in type 1 diabetes
- First-line treatment of type 2 diabetes
- Oral drugs acting on secretion, sensitivity and absorption
- SGLT2 inhibitors and metabolic surgery
- Glucose-lowering drug classes and compounds
- Glucose-lowering drug classes and compounds (continued)
- Glucose-lowering drugs: mechanism and actions
- Glucose-lowering drugs: mechanism and actions (continued)
- Glucose-lowering drugs: mechanism and actions (continued)
- Three goals of preoperative assessment in diabetes
- Nephropathy and autonomic neuropathy
- Gastrointestinal neuropathy and aspiration risk
- Diabetic stiff joint syndrome and the airway
- Oral antidiabetic drugs before surgery
- Properties of common insulin preparations
- Insulin pumps and the standard of preoperative control
- Intraoperative plan and glucose monitoring
- Glucose administration and the patient in ketoacidosis
- Why perioperative hyperglycaemia matters
- How hyperglycaemia harms the surgical patient
- Relation among perioperative injury, hyperglycaemia and outcomes
- Outcome associations with perioperative glucose
- Hypoglycaemia and glucose variability as risks
- Modulators of perioperative hyperglycaemia
- Factors that set perioperative glucose level
- Time course of postoperative insulin resistance
- Intensive insulin therapy and the doubts about it
- NICE-SUGAR versus van den Berghe
- The NICE-SUGAR trial
- Reconciling the two landmark trials
- Evidence after NICE-SUGAR
- Where the glycaemic target now sits
- Recommended glycemic targets in critically ill patients
- Targets outside critical care
- Why subcutaneous insulin fails in theatre
- Accuracy of point-of-care glucose testing
- Perioperative insulin in type 1 diabetes
- Perioperative management in type 2 diabetes
- Two extremes of decompensated diabetes
- Hyperglycemic hyperosmolar state and why it develops
- Diabetic ketoacidosis: definition and clinical picture
- Management of diabetic ketoacidosis
- Insulin therapy in diabetic ketoacidosis
- Fluid therapy and the SGLT2 inhibitor trap
- Potassium in diabetic ketoacidosis
- Bicarbonate, lactic acidosis and complications of ketoacidosis
- Recognising hypoglycaemia and why it is missed
- Three levels of hypoglycaemia
- Treating hypoglycaemia
Pituitary Gland
- Anterior pituitary under- and overactivity
- Acromegaly and its anaesthetic management
- Antidiuretic hormone: action and stimuli for release
- Vascular and haemostatic actions of antidiuretic hormone
- Diabetes insipidus
- Syndrome of inappropriate antidiuretic hormone
- Diagnosis of inappropriate ADH secretion
- Treatment of inappropriate ADH secretion
Endocrine Response to Surgical Stress
- Anaesthesia, catecholamines and endorphins in the stress response
- Measuring and modifying the stress response
Summary and References
- Take-home points: thyroid and parathyroid
- Take-home points: adrenal gland
- Take-home points: diabetes and pituitary
- References
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- Barash, Cullen, and Stoelting's Clinical Anesthesia, 9th Edition