Perioperative management of a patient with myxedema coma and septicemic shock

Baduni, Neha; Sinha, Sunil K.; Sanwal, Manoj Kumar

doi:10.4103/0972-5229.106510

Cited by 3 publications

(8 citation statements)

References 10 publications

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“…Another possible factor contributing to her overall poor clinical outcome is her hypothyroidism status requiring levothyroxine supplementation. There have been case reports of life-threatening myxedema coma and septicemic shock soon after rapid sequence induction [ 8 ]. Myxedema coma can cause a significant drop in metabolic rate which includes hypotension and hypothermia [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…There have been case reports of life-threatening myxedema coma and septicemic shock soon after rapid sequence induction [ 8 ]. Myxedema coma can cause a significant drop in metabolic rate which includes hypotension and hypothermia [ 8 ]. Many patients with long-term hypothyroidism might also have hypopituitarism [ 8 ] which in our patient manifested in the form of adrenal insufficiency [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

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When a Dead Patient Is Not Really Dead: Lazarus Phenomenon

Sharma¹,

Chandna

Nguyen³

et al. 2020

Case Reports in Critical Care

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Lazarus phenomenon refers to autoresuscitation of a patient declared dead after cessation of cardiopulmonary resuscitation (CPR). The Lazarus phenomenon is rarely encountered and pathophysiology is not very well understood, but physicians need to be aware of this phenomenon. It is prudent that a physician leading a CPR effort waits for some time and monitors the patient further using blood pressure and electrocardiogram before confirming that a patient is actually dead.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

When a Dead Patient Is Not Really Dead: Lazarus Phenomenon

Sharma¹,

Chandna

Nguyen³

et al. 2020

Case Reports in Critical Care

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“…Pemberian terapi hormon pengganti yang dimulai sejak prabedah dilanjutkan hingga periode bedah dan pascabedah. 4,5 Tehnik reseksi hipofisis adalah dengan pendekatan transkranial dan pendekatan endoskopik (pendekatan transnasaltransfenoidal). Pilihan jenis reseksi berdasarkan anatomi lesi, ukuran sella, pengapuran, ukuran, dan pneumatisasi sinus.…”

Section: Pendahuluanunclassified

“…Keberhasilan tindakan neuroanestesi dan operasi pada pasien yang akan menjalani reseksi adenoma hipofisis menjadi tantangan tersendiri bagi dokter spesialis anestesi, baik manajemen preoperasi, intraoperasi, maupun pasca operasi. 4,5…”

Section: Pendahuluanunclassified

“…Kateter arteri juga harus dipertimbangkan pada pasien yang menunjukkan tanda dan gejala gagal jantung kongestif, pasien dengan hipertensi yang sulit terkontrol, atau pada pasien dengan kardiomiopati yang terdokumentasikan. 4,7 Manajemen Post-operatif Pasien pada kasus ini diberikan sedasi analgetik berupa dexmedetomidine 0,2 µg/kgbb/jam. Biasanya pasien mengeluhkan adanya sakit kepala pada sisi frontal setelah operasi.…”

Section: Pembahasanunclassified

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Tatalaksana Anestesi Pasien Adenoma Hipofisis dengan Riwayat Hipotiroid

Maharani

Bisri

Umar

2022

JNI

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Pituitary adenoma is a brain tumor has clinical symptoms depending on hormones produced by tumor cells, size, and local invasion. A 50-year-old woman with pituitary adenoma with history of hypothyroidism. On preoperative, GCS E4M6V5, blood pressure was 114/76 mmHg, pulse was 81x/minute, respiration was 18x/minute, and saturation was 99%. On physical examination, body weight and the visual acuity in the right eye decreased. Examination of thyroid function suggests hypothyroidism before surgery, patient was treated with levothyroxine sodium 100 g per day tablets for 14 days until euthyroid. The next treatment was resection craniotomy of the pituitary adenoma. Premedicated with hydrocortisone 100 mg and midazolam 0.1 mg/kg body weight. Induction propofol 1 mg/kg body weight, fentanyl 2 µg/kg body weight, rocuronium 1 mg/kg body weight, lidocaine 1 mg/kg body weight and repeated doses of 0.5 mg/kg body weight propofol. Mannitol was given 0.5 mg/kgbw and dexamethasone 10 mg. Maintenance anesthesia with sevoflurane 0.5% and propofol 50-100 µg/kgbw/min. Postoperative the patient in the ICU was given dexmedetomidine 0.2 µg/kgbw/hour and steroid supplement day-1 was given 25 mg hydrocortisone every 12 hours. On day-2, 20 mg of hydrocortisone in the morning and 10 mg in the evening, then can be discontinued. The patient was admitted to the ICU for 3 days before moving to the ward. Perioperative management of pituitary adenoma with a history of hypothyroidism is optimizing preoperatively the patient reaches euthyroid, maintaining hemodynamics, optimizing cerebral oxygenation, preventing and treatment if there are complications.

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Postoperative myxoedema coma

James

Vij

et al. 2014

BMJ Case Reports

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SUMMARYHypothyroidism is a commonly diagnosed endocrine disorder in medicine. Hyponatraemia is reported in up to 10% of hypothyroid patients, although it is usually mild and rarely causes symptoms. Myxoedema coma is a rare manifestation of hypothyroidism and it can be lethal if it goes undiagnosed and untreated. Our patient presented with an acute manifestation of probable long-standing, but undiagnosed, hypothyroidism. She was asymptomatic but when subjected to surgery (identifiable stress factor) it precipitated as myxoedema coma. Stressful situations such as surgery or infection are the usual precipitating factors for myxoedema coma. The patient responded well to treatment with levothyroxin, 0.9% saline infusion and other general supportive measures. Judicious use of intravenous saline to correct hyponatraemia is important. Correction with 3% normal saline should be carried out with great caution, as rapid correction with 3% normal saline can lead to central pontine demyelination. BACKGROUND

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Perioperative management of a patient with myxedema coma and septicemic shock

Cited by 3 publications

References 10 publications

When a Dead Patient Is Not Really Dead: Lazarus Phenomenon

When a Dead Patient Is Not Really Dead: Lazarus Phenomenon

Tatalaksana Anestesi Pasien Adenoma Hipofisis dengan Riwayat Hipotiroid

Postoperative myxoedema coma

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