Anesthesia for parathyroid surgery.

Anesthesia for surgery of primary hyperparathyroidism (HPT) usually concern s asymptomatic elderly women with moderate hypercalcemia. Cardiovascular re percussions of the endocrine disorder are possible, but they are not freque nt except for hypertension. Hyperparathyroid crisis is a life-threatening c ondition with severe hypercalcemia. Intravenous diphosphonates are very eff ective drugs to control hypercalcemia. The improvement is transient but all ows curative parathyroidectomy to be performed with a minimal risk of cardi ac arrhythmias. Anesthesia for surgery of secondary HPT concerns patients w ith chronic renal failure treated by hemodialysis. Cardiovascular disease i s frequent and aggravated by the endocrine disorder. In patients with marke d aortic stenosis or severe left ventricular dysfunction, parathyroidectomy should be performed by cervicotomy under local anesthesia. Hyperparathyroi dism may persist after renal transplantation (tertiary HPT): in this case c ardiovascular disease is minimal and the hypercalcemia is moderate. Parathy roidectomy is usually performed by cervicotomy under general anesthesia. St ernotomy is required in the case of an abnormal mediastinal location of a g land. An interaction between myorelaxants and hyperparathyroidism has been observed. Total blood calcium must be systematically assayed postoperativel y because postoperative hypocalcemia is constant. Hypocalcemia is moderate in primary and tertiary HPT, due to transient functional hypoparathyroidism , with lowest observed the 2nd or 3rd postoperative day, Hypocalcemia shoul d not be treated when asymptomatic because it resolutes on the 4th or 5th p ostoperative day. Intravenous calcium infusion may be necessary for 1 or 2 days, if serum calcium is below 1.9 mmol per liter with symptoms of tetany. Persistent hypocalcemia is due to an hungry bone syndrome or organic hypop arathyroidism that should be treated by oral vitamin D and calcium. In seco ndary HPT, hypocalcemia is early, marked and asymptomatic. Treatment must o ften be started on the 6th postoperative hour by intravenous calcium infusi on, followed by oral vitamin D and calcium. The absence of postoperative hy pocalcemia indicate incomplete removal of all abnormal parathyroid tissue. At the third postoperative day, a second cervicotomy may be performed to co mplete the neck exploration.