Perioperative Evaluation and Management of Endocrine Disorders

Himes, Carina P.; Ganesh, Ravindra; Wight, Elizabeth; Simha, Vinaya; Liebow, Mark

doi:10.1016/j.mayocp.2020.05.004

Cited by 38 publications

(64 citation statements)

References 65 publications

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“…The preoperative assessment should include the degree of glycemic control for individuals with diabetes and thyroid function for patients with thyroid disease. 45 Patients with DS who have preexisting endocrine conditions and are undergoing surgery require special consideration during preoperative evaluation and postoperative care.…”

Section: Endocrinementioning

confidence: 99%

Down Syndrome: A Review of Key Perioperative Implications

Hines¹,

Simmons²

2022

AORN Journal

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Down syndrome (DS) is the most common chromosomal abnormality in humans that is compatible with life. This syndrome occurs when there is an extra copy of the 21st chromosome. Down syndrome is associated with numerous comorbidities that can pose challenges for the perioperative nurse caring for a patient with DS undergoing surgery. These challenges can affect the patient assessment, communication with the patient, and patient safety (eg, preventing complications). As the life expectancy of people with DS has increased, so too have the chances that perioperative nurses will care for a patient with this disorder. This article reviews the pathophysiology of DS, discusses common comorbidities that may directly affect perioperative care, and reviews an exemplar case study that demonstrates how personnel with knowledge of DS can positively influence surgical team decision making for these patients in the perioperative setting.

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Section: Endocrinementioning

confidence: 99%

Down Syndrome: A Review of Key Perioperative Implications

Hines¹,

Simmons²

2022

AORN Journal

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“…The American Diabetes Association recommends screening for diabetes in all overweight patients who have an additional risk factor. Risk factors include a history of cardiovascular disease, hypertension, hyperlipidemia, polycystic ovarian syndrome, or gestational diabetes, a first-degree relative with diabetes, or a higher risk race or ethnicity[ 14 , 15 ]. These guidelines are not specific for patients having surgery, however it makes intuitive sense to screen these patients, who are at risk for diabetes, before surgery.…”

Section: Pre-operative Assessment and Managementmentioning

confidence: 99%

“…In general, elective surgical procedures do not need to be cancelled or postponed, if the patient accidentally took an oral antidiabetic medication on the day of surgery. Cancellation of postponement of elective surgery should be considered if the patient accidentally took any SGLT 2 inhibitor or a sulfonylurea because of the risk of hypoglycemia or diabetic ketoacidosis[ 15 ].…”

Section: Pre-operative Assessment and Managementmentioning

confidence: 99%

Perioperative challenges in management of diabetic patients undergoing non-cardiac surgery

Galway¹,

Chahar²,

Schmidt³

et al. 2021

WJD

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Prediabetes and diabetes are important disease processes which have several perioperative implications. About one third of the United States population is considered to have prediabetes. The prevalence in surgical patients is even higher. This is due to the associated micro and macrovascular complications of diabetes that result in the need for subsequent surgical procedures. A careful preoperative evaluation of diabetic patients and patients at risk for prediabetes is essential to reduce perioperative mortality and morbidity. This preoperative evaluation involves an optimization of preoperative comorbidities. It also includes optimization of antidiabetic medication regimens, as the avoidance of unintentional hypoglycemic and hyperglycemic episodes during the perioperative period is crucial. The focus of the perioperative management is to ensure euglycemia and thus improve postoperative outcomes. Therefore, prolonged preoperative fasting should be avoided and close monitoring of blood glucose should be initiated and continued throughout surgery. This can be accomplished with either analysis in blood gas samples, venous phlebotomy or point-of-care testing. Although capillary and arterial whole blood glucose do not meet standard guidelines for glucose testing, they can still be used to guide insulin dosing in the operating room. Intraoperative glycemic control goals may vary slightly in different protocols but overall the guidelines suggest a glucose range in the operating room should be between 140 mg/dL to 180 mg/dL. When hyperglycemia is detected in the operating room, blood glucose management may be initiated with subcutaneous rapid-acting insulin, with intravenous infusion or boluses of regular insulin. Fluid and electrolyte management are other perioperative challenges. Notably diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic state are the two most serious acute metabolic complications of diabetes that must be recognized early and treated.

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“…Based on the morning cortisol result, a corticotropin stimulation test may be warranted as shown in Table 1. 28 Covid-19 is usually associated with hypokalemia due to pulmonary ACE 2 downregulation, decreased angiotensin-II depletion and enhanced secretion of aldosterone hormone from the adrenal glands.Moreover, a noticeable association between hypernatremia, hypokalemia, and hyporeninemichypoaldosteronism with new onset of hypertension among Covid-19 patients also being reported. 18 Findings also suggested low levels of dehydroepiandrosterone sulphate (DHEAS) in 13.1% patients after adjusting for age, sex and menopausal status.…”

Section: Adrenal Gland Dysfunctionmentioning

confidence: 99%

The anesthesiologist and Covid-19 endocrinopathies

Desai

Chhanwal²

2021

IJCA

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Covid-19 disease created a havoc since 2019, affected large number of number of people over worldwide. As the second wave is receding, we will be receiving patients with the long-term effects of Covid-19 for the surgeries either for their primary disease or for the complications arising from the Covid-19. Primarily, the Covid-19 is a disease affecting the pulmonary and cardiac system, many other systems including renal, hematology, central nervous, endocrine etc. also damaged with the same. Various endocrine glands are being involved in Covid-19 disease like pancreas, thyroid, pituitary, adrenals, reproductive system etc. as they are highly expressed with ACE. This may even lead to the permanent damage. Because of the unfamiliarity with the disease, plausible impact on the endocrine functions is still unclear. This article elaborates various endocrine manifestations of SARS Cov and SARS Cov-2 for better understanding and management of Covid-19 recovered patients.

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Perioperative Evaluation and Management of Endocrine Disorders

Cited by 38 publications

References 65 publications

Down Syndrome: A Review of Key Perioperative Implications

Down Syndrome: A Review of Key Perioperative Implications

Perioperative challenges in management of diabetic patients undergoing non-cardiac surgery

The anesthesiologist and Covid-19 endocrinopathies

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