Clinical aspects of endocrinology

Providing anaesthesia for surgery of the endocrine system requires an understanding of the physiology, pathology, anatomy and pharmacology of the endocrine organs. The physiology and pharmacology determine how the patient’s condition may be controlled preoperatively and what disturbances may happen intraoperatively and postoperatively. The anatomy and surgical pathology determine the nature and extent of the procedure and (in the case of the thyroid gland) any likely impact on airway control. This article discusses anaesthetic management for surgery of the thyroid and parathyroid glands and for surgery related to conditions of the adrenal cortex. In the case of thyroid surgery, the importance of tracheal distortion, control of thyrotoxicosis and occurrence of postoperative airway problems are emphasized. For parathyroid surgery, the consequences of hypercalcaemia and of a sudden reduction in parathyroid hormone concentrations are discussed. Conditions of the adrenal cortex vary in severity and often require judgement as to preoperative optimization, the use of invasive monitoring and the appropriateness of postoperative critical care. These issues are discussed. Postoperative pain is rarely a problem (particularly with the increased use of laparoscopic surgery) and postoperative stay is short. Some procedures are now being performed as day cases with careful postoperative protocols. The input of a motivated endocrinologist is essential both for preoperative management of these sometimes complex cases and for postoperative management of hormone replacement. Close collaboration among surgeon, anaesthetist and endocrinologist is essential.