Anaesthetic Management of a Patient with Thyrotoxicosis for Nonthyroid Surgery with Peripheral Nerve Blockade

Abstract

Thyrotoxicosis is a hypermetabolic condition caused by an elevation in thyroid hormone levels. The disorder has a variety of causes, manifestations, and therapies. Several clinical features of thyrotoxicosis are due to sympathetic stimulation with increased beta-adrenoreceptor upregulation and sensitization to catecholamine. Anaesthetic management of thyrotoxicosis patients using neuraxial block has been described in literature; however, to our knowledge, there are no reports of peripheral nerve block utilization. Here, we report on the anaesthetic management of a patient with thyroiditis-associated thyrotoxicosis undergoing emergency surgery via a femoral and sciatic nerve block.

Thyroid storm: Does dexmedetomidine have a role?

“…Patients with hyperthyroidism who are not rendered euthyroid preoperatively are at a serious risk of developing perioperative thyroid storm which has a high mortality. [ 1 ] This life-threatening exacerbation of the thyrotoxic state can present 4–6 h postoperatively after thyroid surgery in uncontrolled hyperthyroid patients, as happened in our patient. Thyroid storm is essentially a clinical diagnosis; thus, to assess the degree of dysfunction, the Burch and Wartofsky score[ 2 ] is used.…”

Urgent surgery in a poorly controlled hyperthyroid patient

“…There are case reports of successful management of patients with thyrotoxicosis for non-thyroid surgery with esmolol infusions. 4 We used MgSO4 at the induction considering its membrane stabilizing effects, antiarrhythmic effect and negative inotropic effect. It worked well in this patient as heart rate was well controlled with MgSO4 throughout the intraoperative period.…”

Experience of Dexmedetomidine Use in Surgery in Patients With Thyrotoxicosis

“…Серцево-судинні ефекти мають дозозалежний характер. Крім того, дексмедетомідин може послабити періопераційний стрес, ступінь запалення та захистити імунну систему у пацієнтів хірургічного профілю [16][17][18][19].…”