Endocrine Diseases and Anesthesia

Diabetes Mellitus:
-type 1 – abs insulin deficiency
-type 2 – adult onset
-type 3 – genetic defect
-type 4 – gestational

-delayed gastric emptying

-a/w stiff joint syndrome – deposition in joints affecting TM, Atlanto occipital and othe rcervical
spine immobility (C1-2) as predictor of difficult ETT intubation
-DM is leading cause of end stage renal failure  proteinuria first

-preop goal 110-180

->350 sugar – cancel case electively

-omit morning insulin to prevent hypoglycemia

-omit morning PO hypoglycemic and metformin omitted night before (lactic acidosis)
-epidural steroid cause blood glucose
-opioid agonists inc hypoglycemic risk; opioid antagonist improve hypoglycemia

Pheo:
-most pheo produce noradrenaline (vs adrenaline)
-adrenalne pheo pt many more sx – panic attacks, sweating, hypoglycemia, tachy,
tachyarrhythmias
-diagnosis: urine VMA, elevated urinary normetanephrine/metanephrine
-Ct scan with contrast, MRI
-management: must alpha block prior to beta blockers!! Take 10-15 days to normalize values
with alpha blocker.
-phenoxybenzamine dissipates over 36 hours (postop can be sleepy due to persistent central a2
block and may require large IV fluids until block has worn off)
-criteria for optimal periop control: bp <160/90, orthostatic hypoTN <80/45, asbcence ST
changes >1 min

-sevo, iso ok. No research with desflurane (SNS stimulation).

-propofol, thiopental, etomidate ok.
-ketamine, pancuronium, ephedrine – avoid. Avoid histamine release – morphine, atracurium.
-can use esmolol, labetolol

-BP control: phentolamaine (a2 weakly, a1 competitive), sodium nitroprusside (rapid onset,
short duration, CN toxicity in high doses), nitroglycerin, mg (antiarrhythmic with ca blockade,
vasodilation, inhibit catechoalamine release. Not used often).

Cushings Syndrome
-any pt >5mg of steroids of any kind PO/IV/ for more than 2 weeks in period of 12 months get
stress dose
-minor sx: 50-100 mg bolus