Recent Updates And Guidelines in Endocrinal Crisis during general anesthesia

Abstract

Endocrine emergencies pose unique challenges for the attending anesthetic specialist while managing endocrinal crisis. Besides taking care of primary disease state, one has to divert an equal attention to the possible associated endocrinopathies also. One of the common reasons for inability to timely diagnose an endocrinal failure in patients being the dominance of other severe systemic diseases and their clinical presentation. The timely diagnosis and administration of therapeutic interventions for these endocrine disorders can improve the outcome. The timely diagnosis and administration of timely therapeutics in common endocrine disorders like severe thyroid storm, acute adrenal insufficiency, pheochromocytoma, diabetic ketoacidosis and carcinoid crisis significantly influence the outcome and prognosis. Careful evaluation of clinical history and a high degree of suspicion are the corner stone to diagnose such problems. Aggressive management of the patient is equally important as the complications are devastating and can prove highly fatal. Endocrinalemergencies pose numerous unique challenges during surgical, anesthetic and intensive care management. The advancements in neuro-endocrine surgical interventions, both diagnostic and therapeutic, have been well supported by similar advancements in anesthesiology and intensive care. The advent of new anesthetic drugs, adjuvants, cardiac agents, cerebro-protective agents, etc. has made the preoperative, peri-operative and postoperative management of these surgical procedures relatively easy. Safe and quality anesthesia practices mandate a thorough pre-operative assessment and preparation of the patient for surgery. Surgery on endocrinal crisis are quite unique as it involves the principles and practices of both endocrine and anesthesiology management. The challenges to the anesthesiologist become manifold as the surgical approach differs in different patients A multidisciplinary approach involving the endocrine surgeon, , anesthesiologist, endocrinologist and intensivist is mandatory during the preoperative, peri-operative and postoperative period for a successful surgical outcome. In-depth knowledge of the anatomical and pathophysiological aspects of different endocrinal glands is very essential as it can have various implications for the concerned anesthesiologist so as to deliver safe and smooth anesthesia services. We tried to review some of the common endocrine emergencies in intensive care unit and the challenges associated with their diagnosis and management and to review and discuss some of the most important recent and advanced clinical aspects regarding the anesthesia and intensive care implications in endocrinal crisis.