1 / 18

Pre –operative Evaluation in Diabetes , Thyroid Diseases

Pre –operative Evaluation in Diabetes , Thyroid Diseases. Haddadi S MD Guilan University of Medical Sciences. Diabetes Mellitus. Accidental BS >200 mg/dl FBS >126 mg/dl GTT > 200 mg/dl. Pre-op in diabetics patients :.

elusk
Télécharger la présentation

Pre –operative Evaluation in Diabetes , Thyroid Diseases

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Pre –operative Evaluation in Diabetes , Thyroid Diseases Haddadi S MD Guilan University of Medical Sciences

  2. Diabetes Mellitus • Accidental BS >200 mg/dl • FBS >126 mg/dl • GTT > 200 mg/dl

  3. Pre-op in diabetics patients : • Diabetics are at risk for multi organ dysfunction , with renal insufficiency , stroke , peripheral neuropathy , autonomic dysfunction ,cardiovascular disease , delayed gastric emptying , retinopathy ,reduced joint mobility • CAD equivalent • Autonomic neuropathy is the best predictor of silent ischemia • Poorly controlled BS ,longer duration of disease correlate with cardiac risk ,increased risk for heart failure

  4. Heart failure is twice in men , 5 times as common in women with DM as in non-DM • Increased risk for renal failure peri -operatively , post –op infections • Poorly controlled diabetic patients are at risk for the development of stiff joint syndrome with reduced cervical mobility

  5. Waxy edema • Non pitting edema in neck ,back of neck • Diabetic scleroderma • Gastroparesia ,risk of aspiration (NPO)

  6. Pre op evaluation: • Assessing organ damage • Control of BS • CVS ,renal ,neurologic systems ,musculo skeletal (non-enzymatic glycozilation in proteins ,abnormal connections in collagen)

  7. Pre-op ECG • Electrolytes • BUN , Creatinine • BS • Patients with autonomic neuropathy , risk of silent ischemia stress test

  8. In renal disease ,control of HTN • Hydration status • Avoiding from nephrotoxic drugs • Autonomic neuropathy ,peri- op cardiac dysrhythmia , hypotension • Patients with autonomic dysfunction or hypovolemia will have greater than a 20 mmHg drop in SBP ,10 mmHg drop in DBP when assuming upright position from recumbence

  9. Goals of peri-op diabetic management: • Avoidance of hypoglycemia • Avoidance of marked hyperglycemia • Target FBS <110 mg/dl in non critically ill hospitalized patients

  10. 2/3 NPH ,Regular nocturnal dosage (pre-op) • ½ NPH morning dosage • Pump : reducing the infusion speed 30% • 2/3 Glarigin nocturnal dose(pre-op) ,elimination diurnal dose • Ablation oral hypoglycemic drugs from 24-48 hours pre operatively (Sulfonilurease)

  11. Pre op evaluation in Thyroid disorders: • Pre –op euthyroid state • Mild to moderate dysfunction probably has minimal impact peri-op • Significant hyper , hypothyroidism appears to increase peri-op risk • Amiodarone ⇨risk for hypothyroidism, TFT before surgery

  12. Patients with a history of chronic thyroid disease need TFT before surgery • If symptomatology ,therapy have not changed ,tests within 6 months before surgery are adequate • TSH are best to evaluate for hypothyroidism • Free T3,T4, TSH is useful in hyperthyroid state

  13. Elective surgery should be postponed until patients are euthyroid • Pre-op consultation with an endocrinologist ,if surgery is urgent in patients with clinical thyroid dysfunction • Continuation of thyroid replacement medications & antithyroid drugs such as PTU on the day of surgery

  14. TFT • Upper airway evaluation ( CXR,CT scan) • Eye protection • Decreased gastric emptying in hypothyroidism (regurgitation) • Vocal cord edema , large goiter • ⇩CO (S.V.,HR ,Baroreceptor reflex) • ⇩responsiveness to hypoxia ,hypercarbia • Risk of hypothermia • Platelet dysfunction , ⇩factor 8,Na,Glc

  15. Angina is unusual in hypothyroidism • Thyroid hormone replacement • IHD ,coronary angiography ,CABG

More Related