Beta‐adrenoceptor blockade and anaesthesia for thyroidectomy

Abstract

SummaryThe administration of beta-adrenoceptor As the clinical features of hyperthyroidism closely resemble those of increased sympathetic activity, it has been believed for many years that the disease may be due to a disorder of the autonomic nervous system. Attempts have been made to reduce the sympathetic component of hyperthyroidism by surgical' (cervical sympathectomy) or medical2. (catecholamine depleting drugs) means. Following the development of beta-adrenoceptor blocking agents their use in this disease was therefore a logical one. Although the evidence for sympathetic overactivity in hyperthyroidism has recently been in dispute, beta-blocking drug therapy has been proved to alleviate effectively many of the symptoms of hyperthyroidism that have been attributed to sympathetic overactivity. A high frequency of adverse reactions associated with the first betablocking drug, pr~nethalol,~ caused its use to be discontinued. Several controlled clinical trials on its successor propranolol, however, soon demonstrated its beneficial effects in hyperthyroidism. 5,

2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis

“…Thyrotoxic crisis during or after the operation, can result in extreme hypermetabolism, hyperthermia, tachycardia, hypertension, coma, or death. Therefore, prevention with careful preparation of the patient is of paramount importance (281,282). The literature reports a very low risk of anesthesiarelated mortality associated with thyroidectomy (254,283).…”

Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists

“…Thyrotoxic crisis during or after the operation can result in extreme hypermetabolism, hyperthermia, tachycardia, hypertension, coma, or death. Therefore, prevention with careful preparation of the patient is of paramount importance (170,171). The literature reports a very low risk of anesthesiarelated mortality associated with thyroidectomy (151,172).…”

Beta-blockers and the thyrotoxic patient for thyroid and non-thyroid surgery: A clinical review

“…The circumstances in which thyroid storm occurred were either the dosage of propranolol being too low (160 mg/day or less) or the response to beta-blocker therapy not iodine in the preoperative treatment and stabilization of the thyrotoxic patient. These results are summarized in Table 2 [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] . They show that this regime can safely provide rapid control of the peripheral manifestations of hyperthyroidism, producing a clinically euthyroid patient in a relatively short period of time.…”

“…In view of the established safety of conventionally prepared thyrotoxic patients for surgery, it is essential that any deviation from this is comparably safe and effective 31 . During the 1970s to the mid-1990s, numerous studies were performed with results advocating the use of beta-blockers, in particular propranolol, alone or in combination with studied 12 patients prepared with either nadolol or atenolol without iodine.…”