Anesthesia and Hypoparathryroidism
-
Usually follows parathyroidectomy
- Cardiovascular
-
hypotension
CHF
ECG changes (prolonged QT interval)
- Musculoskeletal
-
muscle cramps
weakness
- Neurologic
-
neuromuscular irritability
-
laryngospasm
inspiratory stridor
tetany
seizures
Chvostek's sign-
facial nerve tap -> face twitches painfully
-
tourniquet for 3 minutes -> carpopedal spasm
mental status changes-
dementia
depression
psychosis
Manifestations (of hypocalcemia)
-
renal failure
hypomagnesemia
vitamin D deficiency
acute pancreatitis
-
calcium chloride IV slow
Anesthetic Considerations
- CaCl2 to normalize Ca if cardiac manifestations
- Avoid hyperventilation (or sodium bicarbonate) which will decrease ionized Ca level
- Beware citrate-containing blood products (decrease Ca level)
- Avoid 5% albumin (may lower ionized Ca level)
- May be more sensitive to neuromuscular blocking drugs
