Effect of general anesthesia and intubation on parathyroid levels in normal patients and those with hyperparathyroidism

Cinamon, Udi; Gavish, Doron; Tamir, Sharon Ovnat; Goldfarb, Alvin I.; Ezri, Tiberiu

doi:10.1002/hed.25002

Cited by 4 publications

(2 citation statements)

References 43 publications

(145 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A reduction in intraoperative PTH by more than 50% after the procedure is a predictive factor [22,23] and may be prevented by preoperative supplementation with bisphosphonates [24,25]. Age is not a relevant contributing factor for the occurrence of complications [26,27], while anesthesia can often cause sudden elevation of PTH levels in patients suffering from hyperparathyroidism [28,29] and can worsen renal functions [30,31]. The latest works shows that minimally invasive radio-guided parathyroidectomy using a very low dose of Tc-99 MIBI, even without an intraoperative assay or a frozen section analysis, resulted in an excellent cure rate [32,33].…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Primary Hyperparathyroidism—Clinicopathologic Study of 1019 Cases from a Single Institution

Gawrychowski

Kowalski

Buła

et al. 2020

JCM

View full text Add to dashboard Cite

Background: Primary hyperparathyroidism (pHPT) is an endocrine disorder characterized by hypercalcemia and caused by the presence of disordered parathyroid glands. Parathyroidectomy is the only curative therapy for pHPT, but despite its high cure rate of 95–98%, there are still cases where hypercalcemia persists after this surgical procedure. The aim of this study was to present the results of a surgical treatment of patients due to primary hyperparathyroidism and failures related to the thoracic location of the affected glands. Methods: We present a retrospective analysis of 1019 patients who underwent parathyroidectomy in our department in the period 1983–2018. Results: Among the group of 1019 operated-on patients, treatment failed in 19 cases (1.9%). In 16 (84.2%) of them, the repeated operation was successful. In total, 1016 patients returned to normocalcemia. Conclusions: Our results confirm that parathyreoidectomy is the treatment of choice for patients with primary hyperparathyroidism. The ectopic position of the parathyroid gland in the mediastinum is associated with an increased risk of surgical failure. Most parathyroid lesions in the mediastinum can be safely removed from the cervical access.

show abstract

Section: Discussionmentioning

confidence: 99%

Surgical Management of Primary Hyperparathyroidism—Clinicopathologic Study of 1019 Cases from a Single Institution

Gawrychowski

Kowalski

Buła

et al. 2020

JCM

View full text Add to dashboard Cite

show abstract

“…But on the other hand, PTH level influenced by some many factors including stress, stress hormones (such as catecholamines, cortisol and inulin), general anesthesia and endotracheal intubation (the most stress-baring procedure), calcium, magnesium, vitamin D, anesthetic agents (propofol) and laparoscopic surgeries (elevated blood CO 2 may change blood pH and cause a shift of ionized calcium [15,16]. Also previous studies reported that propofol influence PTH level; Kivela et al results suggests that there is no need to avoid propofol during parathyroid surgery as previously suggested [16]. Whether propofol affects PTH level or not is still debate so we prefer inhalation anesthesia and desflurane as inhalation anaesthetic.…”

Section: Discussionmentioning

confidence: 99%

Anesthesia for Transoral Endoscopic Parathyroidectomy by Vestibular Approach (TOEPVA)

Yilmaz

Baş

2020

Preprint

View full text Add to dashboard Cite

Introduction: After thyroid diseases, hyperparathyroidism is one of the most common endocrine surgical disease. The increasing diagnosis of thyroid pathologies in early stages and a societal emphasis on physical appearances, especially in young women, have been led to development of new surgical techniques alternative to conventional transcervical incision consistently. Here, we describe our anaesthesia experience for parathyroidectomy with Transoral Endoscopic Parathyroidectomy by Vestibular Approach (TOEPVA). Material-method: Patients undergo TOEPVA at the Health Sciences University Izmir Bozyaka Training and Research Hospital between November 2018 and April 2019 were reviewed. Demographic data and hemodynamic parameters were reported. Seven patients were operated successfully by this technique none of which required conversion to conventional open surgery. Two patient required atropine and one patient required ephedrine during insufflation. Conclusion: After induction of anaesthesia with propofol, remifentanil and rocuronium; anaesthesia managed by desflurane co-administered with continous infusion of remifentanil, provide feasible and safe anaesthesia for TOEPVA. However, especially during hydrodissection and insufflation, a close cooperation between surgeon and anaesthetist have a great value to improve patient management.

show abstract

Challenging treatment of severe hypotension following tracheal intubation in a patient with primary hyperparathyroidism: A case report

Koyama,

Hamaguchi

2024

Medicine

View full text Add to dashboard Cite

Rationale: Primary hyperparathyroidism (PHPT), which is characterized by increased parathyroid hormone secretion, typically manifests as hypercalcemia and hypertension. Here, we report a case of severe hypotension following tracheal intubation during anesthesia induction in a patient with PHPT, in contrast to the expected hypertensive response. Patient concerns: A 52-year-old man presented with nausea after eating, leg pain when walking, and headaches. Diagnosis: Based on the blood test and computed tomography results, he was diagnosed with PHPT. Interventions: The patient underwent parathyroidectomy under general anesthesia. After induction anesthesia and tracheal intubation, severe acute hypotension and tachycardia suddenly developed. To treat hypotensive shock, we immediately administered ephedrine and phenylephrine and infused Ringer solution. Outcomes: The symptoms of hypotensive shock were alleviated by this intervention. Lessons: We speculate that the cause of his severe hypotension was vasodilation due to the transient release of parathyroid hormone from mechanical stimulation by anesthetic procedures, such as tracheal intubation, combined with hypercalcemia-induced severe dehydration. Moreover, we speculate that fluid resuscitation stabilized his condition and helped achieve a successful surgical outcome. The possibility of severe hypotension after anesthesia induction should be anticipated, and management of cases with severe dehydration should be optimized during the anesthetic management of patients with PHPT.

show abstract

Effect of general anesthesia and intubation on parathyroid levels in normal patients and those with hyperparathyroidism

Abstract: General anesthesia and endotracheal intubation causes an immediate, steep, and significant PTH elevation in patients with primary HPT but only a minor change in healthy adults. The difference may be attributed to an impaired adrenergic response in patients with primary HPT.

Cited by 4 publications

References 43 publications

Surgical Management of Primary Hyperparathyroidism—Clinicopathologic Study of 1019 Cases from a Single Institution

Surgical Management of Primary Hyperparathyroidism—Clinicopathologic Study of 1019 Cases from a Single Institution

Anesthesia for Transoral Endoscopic Parathyroidectomy by Vestibular Approach (TOEPVA)

Challenging treatment of severe hypotension following tracheal intubation in a patient with primary hyperparathyroidism: A case report

Contact Info

Product

Resources

About