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Endocrine Disorders (Diabetes (Perioperative glucose control (Pre…
Endocrine Disorders
Diabetes
Perioperative glucose control
Risks of poor control (HbA1c >6-7%)
SSI
Infectious complications
Pulmonary or renal complications after cardiac
Intraoperative Target Glucose
Avoid hypoglycaemia and aggressive control <7mmol/L
Treat if >7.9mmol/L
Definitely treat >10mmol/L
Cardiac surgery: more insulin resistance and glucose production
Pre-operative Anti-glycaemics
Insulins
Long acting: 50-80%
Prandial: omit DOS
Pituitary
Addisons
Signs/Symptoms
Hypotension
N&V
Metabolic acidosis
Hyponatraemia
Hyperkalaemia
Hypoglycaemia
Postural hypotension
Seizures
Causes
Primary
Pituitary resection
Acromegaly?
Autoimmune
TB
Similar to chronic steroid use
Anaesthetic Considerations
Treat electrolytes
Treat hypotension
Replace steroids: 100mg hydrocortisone / 24hrs = sufficient
Acromegaly
Problem of overgrowth
Growth Hormone excess
Soft tissues
Tongue - airway
Face - airway
Hands and feet - positioning
Throat - thyroid and RLN
Nerve entrapment (CPN)
Skeletal
Mandible/maxilla - airway
Kyphosis - restrictive lung
Organs
Cardiomegaly
Arrythmias
Hypertension
CCF
Liver and Spleen
Thyroid - RLN
Diabetes in 25% + sequelae
Transphenoidal resection of pituitary
Bitemporal visual field defects
Conns Syndrome