Anesthesia and Hyperparathryroidism
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Etiology
- Primary hyperparathyroidism
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adenoma
carcinoma
hyperplasia of the parathyroid gland
- Secondary hyperparathyroidism
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renal failure
intestinal malabsorption sydromes
- Ectopic hyperparathyroidism
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tumors outside the parathyroid gland
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parathyroid hormone-related peptide
hepatoma
bronchogenic carcinoma
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Cardiovascular
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hypertension
ventricular dysrhythmias
ECG changes (shortened QT interval; or prolonged QT if Ca > 16 mg%)
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impaired concentrating ability
hyperchloremic metabolic acidosis
polyuria
dehydration
polydipsia
renal stones
renal failure
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ileus
nausea and vomiting
peptic ulcer disease
pancreatitis
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muscle weakness
osteoporosis
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delirium
psychosis
coma
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bone metastases
vitamin D intoxication
milk-alkali syndrome
sarcoidosis
prolonged immobilization
Anesthetic Considerations
Preoperative
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Assess volume status
- intravenous biphosphonates
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pamidronate (Aredia)
etridronate (Didronel)
- plicamycin (Mithramycin)
- glucocorticoids
- calcitonin
- dialysis
NS and furosemide as needed to decrease serum calcium to acceptable levels (< 14 mg% = 7 mEq/L)
Rarely, need more aggressive therapy:
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Hydrate well to minimize induction hypotension
Avoid hypoventilation acidosis (increases ionized calcium level)
Cardiac dysrhythmias
Osteoporosis
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Complications of parathyroidectomy are those of
subtotal thyroidectomy
