Corneci Marioara, Stanescu Bogdan, Trifanescu Raluca, Neacsu Elena, Corneci Dan, Poiana Catalina, Horvat Teodor
"C.I. Parhon" National Institute of Endocrinology, Bucharest, Romania.
Maedica (Bucur). 2012 Jun;7(2):117-24.
In patients with hyperparathyroidism, parathyroidectomy is the only curative therapy. Anaesthetic management differs function of etiology (primary vs. secondary or tertiary hyperparathyroidism) and surgical technique (minimally invasive or classic parathyroidectomy).
To evaluate peri-operative management (focusing on hemodynamic changes, cardiac arrhythmias and patients' awakening quality) in parathyroidectomy for hyperparathyroidism of various etiologies, in a tertiary center.
292 patients who underwent surgery for hyperparathyroidism between 2000-2011 were retrospectively reviewed; 96 patients (19M/77F) presented with primary hyperparathyroidism (group A) and 196 (80M/116F) 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: 15-65 pg/mL).
Median surgery duration was 30 minutes in group A (minimally invasive or classic parathyroidectomy) and 75 minutes in group B (total parathyroidectomy and re implantation of a small parathyroid fragment into the sternocleidomastoid muscle). During anaesthesia 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 anaesthesia 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.
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 anaesthesia induction in patients with secondary and tertiary hyperparathyroidism.
在甲状旁腺功能亢进患者中，甲状旁腺切除术是唯一的治愈性疗法。麻醉管理因病因（原发性与继发性或三发性甲状旁腺功能亢进）和手术技术（微创或经典甲状旁腺切除术）的不同而有所差异。
在一家三级中心评估各种病因的甲状旁腺功能亢进患者行甲状旁腺切除术时的围手术期管理（重点关注血流动力学变化、心律失常和患者苏醒质量）。
回顾性分析2000年至2011年间接受甲状旁腺功能亢进手术的292例患者；96例患者（19例男性/77例女性）表现为原发性甲状旁腺功能亢进（A组），196例患者（80例男性/116例女性）因肾衰竭导致继发性和三发性甲状旁腺功能亢进（B组）。生化参数（血清钙、磷、肌酐）通过自动化标准实验室方法测定。血清完整甲状旁腺激素（iPTH）通过酶联免疫吸附测定法（ELISA）测量（iPTH正常范围：15 - 65 pg/mL）。
A组（微创或经典甲状旁腺切除术）手术中位时长为30分钟，B组（甲状旁腺全切术并将一小片甲状旁腺组织重新植入胸锁乳突肌）为75分钟。麻醉诱导期间，B组（196例患者中的57例，29.1%）出现动脉低血压的频率显著高于A组（96例患者中的8例，8.34%），p<0.0001，尤其是在接受芬太尼 - 丙泊酚的患者中。手术及麻醉维持期间，A组（96例患者中的67例，69.8%）出现心动过缓的频率显著高于B组（196例患者中的26例，13.3%），p<0.
