Perioperative Challenges in a Primary Hyperparathyroid Patient with Osteitis Fibrosa Cystic and Borderline QTC: A Case-Based Review and Practice Analysis

Progress in Health Sciences 2019; 9(2):57-63.

Posted: 17 Jan 2020

See all articles by Habib Md Reazaul Karim

Habib Md Reazaul Karim

All India Institute of Medical Sciences, Deoghar

Date Written: December 31, 2019

Abstract

Introduction: Perioperative care of primary hyperparathyroidism patients is a significant challenge. The challenge increases when the preoperative optimization of the patient is suboptimal due to any reason. Concomitant complications like osteitis fibrosa cystic, renal involvement, and multiple electrolyte abnormalities predispose these patients towards multiple morbidities and even mortality during the perioperative period. It is known that the hypercalcemia causes shortened QT, and the inhalational and intravenous anesthesia drug-induced QT prolongation is likely to be buffered. On the other hand, prolonged QTc in primary hyperparathyroid patients in the presence of hypercalcemia is more uncommon, but an extremely challenging situation for anesthesiologists as these patients are more prone to torsadogenesity.

Materials and methods: A case-based review is presented in this paper. To review the current practice and opinions, we searched PubMed and Google Scholar using the advanced search engine with the combination index words of primary hyperparathyroidism, anesthesia, anaesthesia, anesthesia management, and anaesthesia management with a time frame of January 1, 2000, to August 30, 2018.

Results: The results are enumerated in the text. Although anesthetic management of primary hyperparathyroid patients is available in the literature, anesthetic management of primary hyperparathyroid patients with prolonged or borderline QTc is not well described. In this paper, we present a case that was successfully managed using Desflurane based minimal flow anesthesia, which is probably also the first of such.

Conclusion: Balanced anesthesia with Propofol induction and modern inhalational agents for maintenance and non-depolarizing neuromuscular blockade appears to be safe method of anesthesia.

Keywords: primary hyperparathyroid, severe hypercalcemia, torsade de pointes, Desflurane, anesthesia

Suggested Citation

Karim, Habib Md Reazaul, Perioperative Challenges in a Primary Hyperparathyroid Patient with Osteitis Fibrosa Cystic and Borderline QTC: A Case-Based Review and Practice Analysis (December 31, 2019). Progress in Health Sciences 2019; 9(2):57-63., Available at SSRN: https://ssrn.com/abstract=3513350

Habib Md Reazaul Karim (Contact Author)

All India Institute of Medical Sciences, Deoghar ( email )

Devipur
Deoghar
DEOGHAR, Jharkhand 814152
India
9612372585 (Phone)

Do you have negative results from your research you’d like to share?

Paper statistics

Abstract Views
183
PlumX Metrics