Perioperative challenges in a primary hyperparathyroid patient with osteitis fibrosa cystic and borderline QTc: a case-based review and practice analysis

Abstract

<b>Introduction:</b> Perioperative care of primary hyperparathyroidism patients is a significant challenge. The challenge increases when the preoperative optimization of the patient is suboptimal due to any reason. Concomitant complications like osteitis fibrosa cystic, renal involvement, and multiple electrolyte abnormalities predispose these patients towards multiple morbidities and even mortality during the perioperative period. It is known that the hypercalcemia causes shortened QT, and the inhalational and intravenous anesthesia drug-induced QT prolongation is likely to be buffered. On the other hand, prolonged QTc in primary hyperparathyroid patients in the presence of hypercalcemia is more uncommon, but an extremely challenging situation for anesthesiologists as these patients are more prone to torsadogenesity. <br><b>Materials and methods:</b> A case-based review is presented in this paper. To review the current practice and opinions, we searched PubMed and Google Scholar using the advanced search engine with the combination index words of primary hyper-parathyroidism, anesthesia, anaesthesia, anesthesia management, and anaesthesia management with a time frame of January 1, 2000, to August 30, 2018. <br><b>Results:</b> The results are enumerated in the text. Although anesthetic management of primary hyperparathyroid patients is available in the literature, anesthetic management of primary hyperparathyroid patients with prolonged or borderline QTc is not well described. In this paper, we present a case that was successfully managed using Desflurane based minimal flow anesthesia, which is probably also the first of such. <br><b>Conclusion:</b> Balanced anesthesia with Propofol induction and modern inhalational agents for maintenance and non-depolarizing neuromuscular blockade appears to be safe method of anesthesia.