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Endocrine and Electrolyte Disorders. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00040-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Agarwal S, Banerjee A, Jain N. Undiagnosed hypothyroidism with delayed recovery: A case report. J Anaesthesiol Clin Pharmacol 2020; 36:279-280. [PMID: 33013055 PMCID: PMC7480317 DOI: 10.4103/joacp.joacp_85_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 03/01/2019] [Accepted: 06/26/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Shilpa Agarwal
- Department of Anesthesiology and Critical Care, UCMS and GTB Hospital, Delhi, India
| | - Ashim Banerjee
- Department of Anesthesiology and Critical Care, UCMS and GTB Hospital, Delhi, India
| | - Nidhi Jain
- Department of Anesthesiology and Critical Care, UCMS and GTB Hospital, Delhi, India
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Şanal Baş S, Ceyhan D, Çobaner N, Bilir A, Güleç SM. Emergency surgery in a newborn patient with severe congenital hypothyrodism. J Clin Anesth 2017; 43:11. [PMID: 28915424 DOI: 10.1016/j.jclinane.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 08/27/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Sema Şanal Baş
- Department of Anaesthesiology and Reanimation, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey.
| | - Dilek Ceyhan
- Department of Anaesthesiology and Reanimation, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
| | - Nurdan Çobaner
- Department of Anaesthesiology and Reanimation, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
| | - Ayten Bilir
- Department of Anaesthesiology and Reanimation, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
| | - Sacit Mehmet Güleç
- Department of Anaesthesiology and Reanimation, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, Turkey
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Zelada H, Huachin M, Villena J. Sigmoid Volvulus In Myxedema Megacolon. AACE Clin Case Rep 2017. [DOI: 10.4158/ep161241.cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Rynn KO, Hughes FL, Faley B. An Emergency Department Approach to Drug Treatment of Hypertensive Urgency and Emergency. J Pharm Pract 2016. [DOI: 10.1177/0897190005278748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patients who present with hypertensive urgency or emergency require immediate attention to assess the severity of illness. Guidelines from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure are available but do little to address the management of acute elevations in blood pressure. Various treatment options, both old and new, exist to manage these patients in the emergency department. Decisions on therapy are patient specific and depend on the underlying cause of elevated blood pressure. This article sets out to describe specific patient presentations and reviews current available options in the management of hypertensive urgencies and emergencies.
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Affiliation(s)
- Kevin O. Rynn
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, and Robert Wood Johnson University Hospital, New Brunswick, New Jersey,
| | - Frank L. Hughes
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, and Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Brian Faley
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, and Robert Wood Johnson University Hospital, New Brunswick, New Jersey
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Moyer J, Jacks L, Hunter JD, Chan G. Slipped capital femoral epiphysis and associated hypothyroidism. A review of the literature with two classic case examples. J Pediatr Endocrinol Metab 2016; 29:427-34. [PMID: 26812778 DOI: 10.1515/jpem-2015-0311] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/02/2015] [Indexed: 11/15/2022]
Abstract
Slipped capital femoral epiphysis (SCFE) is a relatively common hip disorder often seen in overweight, peripubertal children. Although the exact etiology is uncertain, it is generally accepted that underlying endocrinopathies play a role in the pathogenesis. Hypothyroidism is the endocrine disorder cited most commonly in association with SCFE, and patients often have no history of thyroid dysfunction at the time of presentation. Despite being a well-recognized risk factor, recommendations for screening thyroid function in patients with typical presentations of SCFE have not been deemed cost-effective; however, there is data to support screening for hypothyroidism in patients with atypical presentations of SCFE or short stature. Hypothyroidism may have a significant impact on healing and bone union after surgical management of SCFE and there is a paucity of case reports in the literature describing potential peri- and postoperative complications. We performed a systematic review of the literature of all reported cases of SCFE with associated hypothyroidism using the search terms, which demonstrated a physiologic relationship between hypothyroidism and SCFE. Two case reports of SCFE in patients with hypothyroidism and associated complications are presented with the literature review. There is a physiologic relationship between thyroid dysfunction and SCFE, and we postulate that profound hypothyroidism may contribute to delayed healing or nonunion in patients undergoing operative management. We support the recommendation to screen patients with short stature, atypical presentation of SCFE, or perisistent nonunion after surgery. In cases of hypothyroidism, we recommend thyroid hormone replacement and laboratory confirmation of return to euthyroid state prior to operative intervention.
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Abstract
BACKGROUND Demographic change has also caused changes in perioperative intensive care because the proportion of geriatric patients who must undergo surgical procedures is increasing. With the current preoperative assessment instruments, it is still not possible to identify high-risk patients of this collective or to make a reliable prognosis concerning postoperative course. MATERIALS AND METHODS In addition to pain control, important aspects to minimize complications in postoperative intensive care include adequate oxygenation, adequate fluid management, an adequate supply of energy and nutrients, good control of blood sugar levels, and early mobilization of patients. RESULTS The perioperative intensive care treatment of geriatric patients requires the readiness to engage in interdisciplinary collaboration because only with this close dialog can the treatment results be sustained.
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Labarca E, Zapico A, Ríos B, Martinez F, Santamarina M. Superior vena cava syndrome due to a leiomyosarcoma of the anterior mediastinum: A case report and literature overview. Int J Surg Case Rep 2014; 5:984-7. [PMID: 25460453 PMCID: PMC4276077 DOI: 10.1016/j.ijscr.2014.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 09/25/2014] [Accepted: 10/09/2014] [Indexed: 12/12/2022] Open
Abstract
Leiomyosarcomas are rare causes of superior vena cava syndrome. Surgery is the treatment of choice. Specific approaches depend on the neoplasm's size and invasion of neighbouring tissues.
INTRODUCTION Leiomyosarcomas are an infrequent cause of malignant superior vena cava syndrome (VCS). PRESENTATION OF CASE A 51-year old male patient was admitted for a three-day history of dyspnoea, dysphagia and erythema of the head and neck. Computed tomography and magnetic resonance imaging showed a lesion arising on the anterior mediastinum, which was in close proximity with a thrombus in the superior vena cava. Surgical excision was performed, including open resection of the primary tumour and an atrio-innominate vein bypass with 8-mm polytetrafluoroethylene (PTFE). Histology confirmed a leiomyosarcoma and postoperative radiotherapy sessions were performed. Due to evidence of enlargement of the thrombus, a second intervention was undertaken. In this procedure, a remainder of the primary tumour was resected and the superior vena cava reconstructed with an autologous pericardium patch. The patient recovered satisfactorily and was discharged on the seventh postoperative day, with no evidence for relapse after 10 months of follow-up. DISCUSSION Leiomyosarcomas comprise less than 2% of the tumours of the mediastinum and are a rare cause of paraneoplastic VCS. Male patients in their sixties are most commonly affected. Relapses seem to be common, and thus a careful follow-up is often recommended. CONCLUSION In spite of the limited data on the management of thoracic leiomyosarcomas, surgery is currently considered the mainstay of treatment.
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Affiliation(s)
- E Labarca
- Departamento de Cirugía Vascular, Hospital Naval Almirante Nef, Viña del Mar, Chile.
| | - A Zapico
- Departamento de Cirugía Cardiaca, Hospital Naval Almirante Nef, Viña del Mar, Chile
| | - B Ríos
- cultad de Medicina, Universidad Andrés Bello, Viña del mar, Chile
| | - F Martinez
- entro de Investigaciones Biomédicas, Escuela de Medicina, Universidad de Valparaíso, Chile
| | - M Santamarina
- Departamento de Imagenología, Hospital Naval Almirante Nef, Viña del Mar, Chile
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Hodin R, Lubitz C, Phitayakorn R, Stephen A. Diagnosis and management of pheochromocytoma. Curr Probl Surg 2014; 51:151-87. [DOI: 10.1067/j.cpsurg.2013.12.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 12/27/2013] [Indexed: 12/21/2022]
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Xue HY, Lu YN, Fang XM, Xu YP, Gao GZ, Jin LJ. Neuroprotective properties of aucubin in diabetic rats and diabetic encephalopathy rats. Mol Biol Rep 2012; 39:9311-8. [PMID: 22810648 DOI: 10.1007/s11033-012-1730-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 06/06/2012] [Indexed: 12/26/2022]
Abstract
In this study, we determined the neuroprotective effect of aucubin on diabetes and diabetic encephalopathy. With the exception of the control group, all rats received intraperitoneal injections of streptozotocin (STZ; 60 mg/kg) to induce type 1 diabetes mellitus (DM). Aucubin (1, 5, 10 mg/kg ip) was used after induction of DM (immediately) and diabetic encephalopathy (65 days after the induction of diabetes). The diabetic encephalopathy treatment groups were divided into short-term and long-term treatment groups. Treatment responses to all parameters were examined (body weight, plasma glucose, Y-maze error rates and proportion of apoptotic cells). In diabetic rats, aucubin controlled blood glucose levels effectively, prevented complications, and improved the quality of life of diabetic rats. In diabetic encephalopathy, aucubin significantly rescued neurons in the hippocampal CA1 subfield and reduced working errors during behavioral testing. The significant neuroprotective effect of aucubin could be seen not only in the short term (15 days) but also in the long term (45 days), which was a highly encouraging finding. These data suggest that aucubin may be a potential neuroprotective agent.
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MESH Headings
- Animals
- Blood Glucose
- Body Weight/drug effects
- Brain Diseases, Metabolic/drug therapy
- Brain Diseases, Metabolic/etiology
- Brain Diseases, Metabolic/prevention & control
- CA1 Region, Hippocampal/drug effects
- CA1 Region, Hippocampal/pathology
- Cell Survival/drug effects
- Diabetes Mellitus, Experimental/blood
- Diabetes Mellitus, Experimental/complications
- Diabetes Mellitus, Experimental/drug therapy
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/drug therapy
- Iridoid Glucosides/administration & dosage
- Iridoid Glucosides/pharmacology
- Male
- Neuroprotective Agents/administration & dosage
- Neuroprotective Agents/pharmacology
- Pyramidal Cells/drug effects
- Pyramidal Cells/pathology
- Rats
- Rats, Wistar
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Affiliation(s)
- Hong Yu Xue
- Department of Chemistry and Life Science, Suzhou University, No. 49 Middle Bianhe Road, Yongqiao District, Suzhou, 234000 Anhui, People's Republic of China
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Critical Illness–Related Corticosteroid Insufficiency in Small Animals. Vet Clin North Am Small Anim Pract 2011; 41:767-82, vi. [DOI: 10.1016/j.cvsm.2011.03.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Blacker SN, Brown CQ, Tarant NS. Autonomic Dysreflexia-Like Syndrome in a T12 Paraplegic During Thoracic Spine Surgery. Anesth Analg 2010; 111:1290-2. [DOI: 10.1213/ane.0b013e3181f334b8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Patients with endocrinopathies frequently present to the operating room. Although many of these disorders are managed on a chronic basis, patients may have acute changes in the perioperative period that, if left unrecognized, can have a negative effect on perioperative morbidity and mortality. It is imperative that anesthesiologists understand the implications of the surgical stress response on hormonal flux. This article focuses on the 4 most commonly encountered endocrinopathies: diabetes mellitus, hyperthyroidism, hypothyroidism, and adrenal insufficiency. Specific challenges pertaining to patients with pheochromocytoma are also discussed.
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Affiliation(s)
- Benjamin A Kohl
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, 3400 Spruce Street, Dulles Building, Suite 680, Philadelphia, PA 19104, USA.
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Abstract
This article reviews current knowledge concerning the monitoring of endocrine function in patients in the clinical setting. Monitoring techniques are discussed and literature is reviewed regarding diabetes mellitus, thyroid, and parathyroid disorders, pheochromocytoma, adrenal insufficiency, and carcinoid tumors.
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Affiliation(s)
- Vivek Moitra
- Division of Critical Care, Department of Anesthesiology, PH 527-B, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA
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Abstract
Patients with preoperative endocrinopathies represent a particular challenge not only to anesthesiologists but also to surgeons and perioperative clinicians. The "endocrine axis" is complex and has multiple feedback loops, some of which are endocrine and paracrine related, and others that are strongly influenced by the surgical stress response. Familiarity with several of the common endocrinopathies facilitates management in the perioperative period. This article focuses on 4 of the most common endocrinopathies: diabetes mellitus, hyperthyroidism, hypothyroidism, and adrenal insufficiency. Perioperative challenges in patients presenting with pheochromocytoma are also discussed.
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Affiliation(s)
- Benjamin A Kohl
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, 3400 Spruce Street, Dulles Building, Suite 680, Philadelphia, PA 19104, USA.
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Abstract
Patients with preoperative endocrinopathies represent a particular challenge not only to anesthesiologists but also to surgeons and perioperative clinicians. The "endocrine axis" is complex and has multiple feedback loops, some of which are endocrine and paracrine related, and others that are strongly influenced by the surgical stress response. Familiarity with several of the common endocrinopathies facilitates management in the perioperative period. This article focuses on 4 of the most common endocrinopathies: diabetes mellitus, hyperthyroidism, hypothyroidism, and adrenal insufficiency. Perioperative challenges in patients presenting with pheochromocytoma are also discussed.
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Affiliation(s)
- Benjamin A Kohl
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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Liccardi G, Salzillo A, De Blasio F, D'Amato G. Control of asthma for reducing the risk of bronchospasm in asthmatics undergoing general anesthesia and/or intravascular administration of radiographic contrast media. Curr Med Res Opin 2009; 25:1621-30. [PMID: 19469699 DOI: 10.1185/03007990903010474] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND It is well known that patients suffering from bronchial asthma undergoing surgical procedures requiring general anesthesia (GA) or the administration of water soluble radiographic contrast media (RCM) have an increased risk of potentially severe bronchospasm. Nevertheless, little attention has been devoted to the possible preventive measures to reduce the occurrence of this potentially life-threatening event. It has been shown that the most important risk factor for bronchospasm during GA induction and/or the use of RCM is represented by a high degree of bronchial hyperreactivity with airway instability not adequately controlled by long-term anti-inflammatory treatment. AIMS The aim of this commentary is to underline the need for an accurate clinical and functional evaluation of asthmatics undergoing surgical procedures requiring GA or radiological procedures requiring the administration of RCM, as well as to suggest a stepwise preventive pharmacological approach for reducing the risk of bronchospasm. METHODS The authors' suggestions represent clinical experience of the respiratory section of an internal hospital-based working group whose aim is the prevention of asthmatic/anaphylactic/anaphylactoid reactions during the administration of anesthetics and/or RCM. The MEDLINE database was searched with a combination of keywords: general anesthesia, radio contrast media [and] bronchial asthma. The main limitation of this commentary is the scarcity of available literature on this topic. FINDINGS The authors suggest a therapeutic approach before surgical procedures requiring GA and/or RCM administration based on the degree of asthma control as assessed by clinical/functional criteria. In this setting, in addition to the necessity of obtaining the best control of airway reactivity, the authors suggest that an optimal control of asthma symptoms in 'real life' conditions might likely constitute a safety issue in asthmatic patients in the case of emergency procedures.
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Affiliation(s)
- Gennaro Liccardi
- Department of Chest Diseases, Division of Pneumology and Allergology, A. Cardarelli High Speciality Hospital, Naples, Italy.
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Sethi D, Arora MK, Sinha R, Bose S. Anesthetic management of a child with functional adrenocortical tumor for resection. Paediatr Anaesth 2008; 18:1142-3. [PMID: 18950363 DOI: 10.1111/j.1460-9592.2008.02674.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Martin LG, Groman RP, Fletcher DJ, Behrend EN, Kemppainen RJ, Moser VR, Hickey KC. Pituitary-adrenal function in dogs with acute critical illness. J Am Vet Med Assoc 2008; 233:87-95. [PMID: 18593315 DOI: 10.2460/javma.233.1.87] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate pituitary-adrenal function in critically ill dogs with sepsis, severe trauma, and gastric dilatation-volvulus (GDV). DESIGN Cohort study. ANIMALS 31 ill dogs admitted to an intensive care unit (ICU) at Washington State University or the University of Pennsylvania; all dogs had acute critical illness for < 48 hours prior to admission. PROCEDURES Baseline and ACTH-stimulated serum cortisol concentrations and baseline plasma ACTH concentrations were assayed for each dog within 24 hours after admission to the ICU. The change in cortisol concentrations (Delta-cortisol) was calculated for each dog. Morbidity and mortality data were recorded for each patient. RESULTS Overall, 17 of 31 (55%) acutely critically ill dogs had at least 1 biochemical abnormality suggestive of adrenal gland or pituitary gland insufficiency. Only 1 (3%) dog had an exaggerated response to ACTH stimulation. Dogs with Delta-cortisol < or = 83 nmol/L were 5.7 times as likely to be receiving vasopressors as were dogs with Delta-cortisol > 83 nmol/L. No differences were detected among dogs with sepsis, severe trauma, or GDV with respect to mean baseline and ACTH-stimulated serum cortisol concentrations, Delta-cortisol, and baseline plasma ACTH concentrations. CONCLUSIONS AND CLINICAL RELEVANCE Biochemical abnormalities of the hypothalamic-pituitary-adrenal axis indicative of adrenal gland or pituitary gland insufficiency were common in critically ill dogs, whereas exaggerated responses to ACTH administration were uncommon. Acutely ill dogs with Delta-cortisol < or = 83 nmol/L may be more likely to require vasopressors as part of the treatment plan.
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Affiliation(s)
- Linda G Martin
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA 99164-6610, USA
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Arora VM, McGory ML, Fung CH. Quality Indicators for Hospitalization and Surgery in Vulnerable Elders. J Am Geriatr Soc 2007; 55 Suppl 2:S347-58. [PMID: 17910557 DOI: 10.1111/j.1532-5415.2007.01342.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Vineet M Arora
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
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Ghirlanda G, Mancini L. Current perioperative treatment of patients with type 1 and type 2 diabetes. Clin Podiatr Med Surg 2007; 24:365-82; vii. [PMID: 17613381 DOI: 10.1016/j.cpm.2007.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Diabetes mellitus is rapidly increasing, diabetic patients are likely to undergo surgical procedures more than non-diabetic patients, the hospital stay of diabetic patients is longer, and diabetic patients have increased mortality and morbidity. The correct treatment of diabetic patients in the perioperative period is crucial to improve clinical outcomes. Diabetic patients must be carefully evaluated for cardiovascular risk, keeping in mind micro- and macroangiopathic diabetic complications. Metabolic control deserves great attention because hyperglycemia is related to increased complications and worse outcomes. Insulin infusion regimens to achieve near normoglycemia must be implemented in surgical and critically ill patients.
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Affiliation(s)
- Giovanni Ghirlanda
- Università Cattolica del Sacro Cuore, Roma, Italy; Diabetes Clinic, Policlinico A. Gemelli, Roma, Italy.
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Marques RG, Sanjuliani AF. Tratamento cirúrgico da hipertensão arterial secundária com origem na glândula supra-renal. Rev Col Bras Cir 2006. [DOI: 10.1590/s0100-69912006000600014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Over 20 million Americans are affected with asthma. Many will require some type of surgical procedure during which their asthma management should be optimized. Preoperative assessment of asthma should include a specialized history and physical as well as pulmonary function testing. In many asthmatic patients, treatment with systemic corticosteroids and bronchodilators is indicated to prevent the inflammation and bronchoconstriction associated with endotracheal intubation. The use of corticosteroids has not been shown to adversely affect wound healing or increase the rate of infections postoperatively. Preoperative systemic corticosteroids may be used safely in the majority of patients to decrease asthma-related morbidity.
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Affiliation(s)
- Jyothi Tirumalasetty
- Division of Allergy-Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
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Li Pi Shan W, Hatzakorzian R, Sherman M, Backman SB. Upper airway compromise secondary to edema in Graves’ disease. Can J Anaesth 2006; 53:183-7. [PMID: 16434760 DOI: 10.1007/bf03021825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE We report an unusual case of upper airway compromise in a patient with Graves' disease. We speculate that this complication may be due, in part, to poorly controlled hyperthyroidism. CLINICAL FEATURES A 26-yr-old female suffering from Graves' disease underwent a total thyroidectomy. Awake fibreoptic intubation was attempted because of a large goiter and orthopnea. Upper airway edema impeded the passage of an armored 7.5 mm endotracheal tube. She was subsequently intubated awake with a regular 7.5 mm endotracheal tube under direct laryngoscopy over an Eschmann bougie. The patient was extubated in the operating room over a tube exchanger. Two hours later she developed stridor and upper airway obstruction. Using direct laryngoscopy, she was reintubated with difficulty because of upper airway edema. At this time, she manifested signs of thyrotoxicosis which were managed medically. On postoperative day three she underwent a tracheostomy after failing a trial of extubation. The upper airway was edematous with minimal vocal cord movement. On postoperative day nine the tracheostomy was downsized and the patient was sent home. The vocal cords were still edematous with minimal movement. Three weeks later, she demonstrated normal right vocal cord movement and weak left vocal cord movement, and the tracheostomy was decannulated. CONCLUSIONS Uncontrolled hyperthyroid patients with large goiters secondary to Graves' disease may develop edema of the upper airway. A high degree of vigilance for airway obstruction is necessary, with a carefully planned approach at each stage of the patient's hospital course to treat this potentially life-threatening situation.
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Affiliation(s)
- William Li Pi Shan
- Department of Anesthesia, Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec, Canada.
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