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EDITORIAL Page | 1

Endocrine anesthesia: A rapidly evolving
anesthesia specialty
With ever increasing number of pre and peri-operative manner. Hypoglycemia, hyperglycemia, hypocalcemia,
patients presenting for surgery with co-morbid endocrine hyperkalemia, hypokalemia, and many more electrolyte
disorders, the challenges for the anesthesiologists have and metabolic abnormalities are commonly encountered
grown manifold. Apart from caring for the impact of in surgical patients and optimal management of these
surgical pathology on endocrine functions, anesthesiologist complications can greatly help in achieving a better surgical
also confronts endocrine disorders and manages their outcome.[8,9]
possible implications during anesthesia procedures.[1,2]
ANESTHETIC TECHNIQUE: A DIFFICULT CHOICE
DIFFERENT YET SOME COMMON BASE
T he choice of anesthesia is also deter mined
Though on the surface, there does not seem to be any by pathophysiological alterations due to different
similarity between endocrinology and anesthesiology endocrinopathies related to pancreas, thyroid, parathyroid,
specialties if one explores them in chthonic depth, a lot of adrenal, pituitary, and others.[3-7] Autonomic function and
common ground can be observed. Endocrine anesthesia integrity is of utmost importance while formulating the
(EA), an amalgam of these two medical sciences, is fast plan of anesthesia. As autonomic dysfunction is commonly
becoming a distinct specialty on its own and the present encountered in many of the endocrine disorders such
editorial aims to focus on these. as diabetes, adrenal disease, and other, pre-operative
assessment and intra-operative vigilance is important.[3-7,10]
ENDOCRINOLOGICAL CHALLENGES IN ANESTHESIOLOGY Equally, crucial is the assessment of cardiovascular status,
neuro-muscular functions, renal parameters and various
Anesthesia for endocrine surgery is different from that other organ systems, which are directly or indirectly affected
for routine procedures. Peri-operative neurotransmitter by various endocrinopathies.
and hormonal secretion occurring with a deranged
endocrinal milieu in the background can be highly
variable and unpredictable. This may have a direct impact ENDOCRINOPATHIES IN ANESTHESIA AND CRITICAL CARE
on the morbidity and mortality. In both non-endocrine
The modern day anesthesiologist has to look after
and endocrine surgery, the role of pituitary, thyroid,
intensive care services as well. Occurrence of co-morbid
parathyroid, pancreas, adrenal, and various other hormone
endocrinopathies does impact the management and
releasing tissues and organs can have a direct impact on
the surgical outcome.[3-7] Endocrine complications are prognosis of critically ill patients. Timely detection and
more likely to occur in routine daily anesthesia practice in management of endocrinopathies in such patients can be
patients presenting with endocrinopathy, but may occur life-saving.[9-12] Often, patients are either primarily admitted
in all. It is therefore mandatory that an anesthesiologist with uncontrolled diabetes and/or its related complications
should be thoroughly well-versed with all endocrine of diabetes may present as a major co-morbidity during
pathologies and complications, which can be encountered such hospitalization. Similarly, many other endocrine and
during surgical practice so as to “suspect,” “prevent,” metabolic disorders may necessitate critical care admissions
“diagnose,” and “manage” them in a timely and appropriate or are diagnosed for the first time during admission
only.[3-7,13-15] Still, many new endocrinopathies and metabolic
Access this article online
disorders develop de novo during the course of treatment
Quick Response Code:
either due to infections and drug effects/interaction
Website: or can arise as a complication of various therapeutic
www.saudija.org procedures such as de novo endocrinopathy: Acute
hypoparathyroidism after thyroid surgery; hypopituitarism
DOI: after pituitary surgery; longterm Nelson’s syndrome after
10.4103/1658-354X.125890 adrenal surgery; diabetes after transplant new onset diabetes
after transplantation (NODAT) and many more.[3-8]

Saudi Journal of Anesthesia Vol. 8, Issue 1, January-March 2014

Whenever by acting on methionine synthetase enzyme. T4.[3-8.16] Dopamine. vasopressin antagonists for Pre-operative assessment/diagnosis hyponatremia. 8. To enumerate. use of testosterone for cessation of Post-operative management uterine bleeding. In the individual basis as various anesthetic drugs are known to operation theater. IP: 117. Pre-operative preparation fludrocortisone. the role of an endocrinologist is also as a cause of impaired sperm function and teratogenicity underestimated in anesthesiology practice. Issue 1. glucocorticoids. which adhere to strict compliance of medication management in makes it mandatory that intensivists should gear up to various endocrinological disorders can be carried out by diagnose and treat such endocrinological disorders. role of anesthesiologist has grown beyond Educational role of anesthesiology the four walls of operation theater and ICU. insulin for treatment of hyperglycemia Peri-operative monitoring and care and hyperkalemia. Such opportunities can be availed during regional anesthesia and surgical cases being performed under monitored anesthesia care. intra-operative and post-operative period EA – Endocrine anesthesia Vol. Anesthesia guidelines do not appreciate the Oxytocin role of endocrinologists. nitrous oxide has been incriminated Similarly. anesthesiologist. February 09. The clinical effects of these drugs Post-operative stabilization have to be kept in consideration both during elective and Endocrine emergencies in anesthesia and critical care Hormonal excess emergency surgeries. Hyperglycemia practical. an endocrinologist can be immensely helpful in also been ignited about the genetic modifications induced by the effect of inhalational anesthetics. a patient perceive doctor as next to God interfere in endocrine functions. [Downloaded free from http://www.227. Dexmedetomidine Guidelines set by various international endocrinology Endocrine drugs in anesthesiology Glucocorticoids organizations and committees do not address the issues Mineralocorticoids faced by the intensivists and anesthesiologists. disorders such as diabetes and can also convey various Most importantly. In Possible effect of no and other inhalational anesthetics spite of this. terlipressin intensivists. Hormonal deficiencies Electrolyte disturbances NEED FOR INCREASED COLLABORATION Metabolic derangements Endocrine effects of surgery/stress Modern day medicine practice has been fast evolving as Hypercortisolemia a team work among different specialties. are the best example of such pharmacological interaction. and is more likely to imbibe the advice delivered and adhere glucocorticoids causing hyperglycemia in surgical patients to various preventive and therapeutic regimens taught during such a crucial period. and terlipressin for stoppage Anesthesia in endocrine surgery of upper gastro-intestinal (GI) bleeding. and other steroids for various indications Peri-operative maintenance are a few of them. vasopressin. An active For patients participation of anesthesiologist is needed to successfully For family members/attendants manage patients with endocrine disorders during For paramedical staff pre-operative.238. January-March 2014 Saudi Journal of Anesthesia . Many clinical.saudija. anesthetic drugs should be chosen on an other simple preventive and therapeutic strategies.137]  ||  Click here to download free Android application for this journal Bajwa and Kalra: Endocrine anesthesia Page | 2 However. Though controversial. motivation of patients to of endocrinologists in the developing countries. TSH. and legal reasons have compelled the physicians Endocrine effects of anesthesiology drugs/procedures from various specialties to come together on a common Dopamine platform to design various management strategies. many endocrine drugs are being EA increasingly used in anesthesiology and intensive care Anesthesia in endocrine disease practice. it is generally felt that there is a relative shortage [Table 1]. 2014. Furthermore. Concerns have feasible. Table 1: Scope of EA At the same time. Guidelines Insulin by the endocrinologists do not highlight the role of Vasopressin. Apart from that.org on Sunday. these guidelines Methylergometrine have not been completely helpful as they are difficult Endocrine occupational effects of anesthesiology to apply in totality in resource challenged settings. During this period an PHARMACOLOGICAL ASPECTS OF EA anesthesiologist can greatly help in disseminating health Pharmaco-therapeutic properties of various drugs have education and the significance of adherence to strict to be kept in consideration during management of such therapeutic compliance regarding various endocrine patients in intensive care unit (ICU) and operation theaters.

14. Endocrine emergencies in critically ill and nurtured. Bajwa SS. Niezgoda J. Van Uum SH. necessitated that a new sub-speciality of EA be developed 9. Indian J Endocrinol Metab 2011. Perioperative care of diabetic 2. Bajwa SS. Metab 2012. Bajwa SS. Anesthesia and thyroid surgery: endocrine systems. 8. implications for pituitary surgery: Recent trends and The increasing incidence and prevalence of various advancements.56:513-7. Indian J Endocrinol Metab 2012. any surgical procedure with the help of an endocrinologist. Diabeto-anesthesia: A subspecialty needing endocrinopathies in patients receiving anesthesia have endocrine introspection. 5. such a closely co-ordinated team work can help in during pheochromocytoma resection: A challenge to the anesthesiologist. 6.40:1004-15. Kalra S. so far. Kalra S. Kersten JR.org on Sunday. patients: Challenges in diagnosis and management.17:228-34. Kalra S. 12. Anesthetic management of primary How to cite this article: Bajwa SS. Circulation 2007. Modifying cardiovascular 1. Anesthesia and Intensive care the overall anesthesia related morbidity and mortality. Endocrinological milieu can be restored to normal before Cochrane Database Syst Rev 2012. Anesthesiology 2003.15:S224-32. achieving a good anesthesia outcome thereby decreasing 7. Anesthetic considerations in patients. Indian J Endocrinol 1 Department of Endocrinology. Saudi J Anaesth 2013. patients with mitochondrial defects.17:235-9. Indian J Endocrinol Metab 2013. Bajwa SJ. Implications and considerations Overall. Haryana. Coulthard P.238. Saudi Journal of Anesthesia Vol. Bajwa SJ. Bajwa SK. Morgan PG. Lutfy K. Renal endocrine manifestations E-mail: sukhminder_bajwa2001@yahoo. Baruah M. Tavernier B. Warltier DC. Indian J Anaesth 2012.saudija. Friedman TC. Banur.12:CD005367. Paediatr Anaesth 2013. The 17:228-34. Perianesthetic management of patients with endocrine risk in diabetes mellitus. Endocr Rev 2010. Indian J Endocrinol Metab 2011. Gu W.16:252-7. 4. 8. Sanjay Kalra1 in anesthesiology practice: Diagnostic. Bajwa SJ. O'Dell LE. Vuong C. Saudi J Anaesth 2014. 15. effects of opioids and opioid analogs on animal and human 3.16:158-63. The never ending challenges.31:98-132. 11. Bajwa SS.[Downloaded free from http://www. Sehgal V.227. Eur J Anaesthesiol 2001. 10. Indian J Endocrinol Metab 2012. 13. understanding of the molecular genetics. Kulshrestha A. Bajwa SS. Karnal. and management strategies. Department of Anesthesiology and Intensive Care. Vinik AI. February 09. disease. Bajwa SK. Kwatra IS. Endocrine anesthesia: hyperparathyroidism: A role rarely noticed and appreciated A rapidly evolving anesthesia specialty.115:387-97.8:1-3. Sehgal V. Acta Anaesthesiol Scand 1996. Issue 1. Supplemental perioperative steroids for surgical patients with adrenal insufficiency. Yong SL. Wrzosek A. Jindal R. preventive. India.18:277-94. IP: 117.com during polytrauma: A cause of concern for the anesthesiologist. Hypoglycaemia Sukhminder Jit Singh Bajwa. Ziegler D. 2014.7:447-52.137]  ||  Click here to download free Android application for this journal Bajwa and Kalra: Endocrine anesthesia Page | 3 preparing the patient for any elective or emergency surgery. Pagel PS. Indian J Endocr Metab 2013. Reno-endocrinal disorders: A basic Gian Sagar Medical College and Hospital. Diabetic cardiovascular autonomic REFERENCES neuropathy.15:S337-44. Bajwa SJ. January-March 2014 . 16. Punjab.16:722-7. Breivik H. Bharti Hospital and BRIDE. Sehgal V.98:774-9. Scherpereel PA.

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