Endocrine Abstracts

Background: In patients with hyperparathyroidism, parathyroidectomy is the only curative therapy. Anesthetic management differs function of etiology (primary vs secondary or tertiary hyperparathyroidism) and surgical technique (minimally invasive or classic parathyroidectomy).

Aim: To evaluate peri-operative management in parathyroidectomy for hyperparathyroidism of various etiologies, in a tertiary center.

Patients and methods: Two hundred and ninety-two patients who underwent surgery for hyperparathyroidism between 2000 and 2010 were retrospectively reviewed; 96 patients (77F/19M) presented with primary hyperparathyroidism (group A) and 196 (116F/80M) with secondary and tertiary hyperparathyroidism due to renal failure (group B). Biochemical parameters (serum calcium, phosphate, creatinine) were determined by automated standard laboratory methods. Serum intact PTH was measured by ELISA (IPTH – normal range: 10–71 pg/ml).

Results: Median surgery duration was 30 minutes in group A (minimally invasive or classic parathyroidectomy) and 75 min in group B (total parathyroidectomy and re implantation of a small parathyroid fragment into the sternocleidomastoid muscle).

During anesthesia induction, arterial hypotension developed significantly more frequent in group B (57 out of 196 pts, 29.1%) than in group A (8 out of 96 pts, 8.34%), P<0.0001, especially in patients receiving Fentanyl -Propofol.

During surgery and anesthesia maintenance, bradycardia was significantly more frequent in group A (67 out of 96 pts, 69.8%) than in group B (26 out of 196 pts, 13.3%), P<0.0001, especially during searching of parathyroid glands. By contrary, ventricular premature beats were less frequent in group A (25 out of 96 pts, 25.25%) than in group B (84 out of 196 pts, 42.85%), P=0.003. There were no statistically significant differences between the studied group regarding frequency of arterial hypertension and hypotension, paroxysmal atrial fibrillation.

Conclusions: Anaesthetic management in parathyroid surgery may be difficult because of cardiac arrhythmias (bradycardia in primary hyperparathyroidism and ventricular premature beats in secondary and tertiary hyperparathyroidism, respectively) and arterial hypotension during anesthesia induction in patients with secondary and tertiary hyperparathyroidism.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.