Jonnavithula Nirmala, Elmati Praveen Reddy, Duddu Kiran Kumar, Murthy Pvln, Ramachandran Gopinath
Department of Anaesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Andhra Pradesh, India.
Department of Urology and Renal Transplantation, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, Andhra Pradesh, India.
Indian J Anaesth. 2015 Mar;59(3):182-5. doi: 10.4103/0019-5049.153041.
Maintenance of homeostasis during anaesthesia in the patient with two major metabolic disorders whose systemic effects either compliment or contradict each other is a challenge to the anaesthesiologist. A 25-year-old male patient with Cushing's syndrome and known hyperhomocysteinemia was scheduled for open adrenalectomy. Both these disorders compound the hypercoagulable state and differ in glucose metabolism. In addition, obesity, difficult airway, electrolyte and metabolic derangements that accompany Cushing's syndrome warrant special attention. He was on anticoagulant therapy and inferior vena cava filter following an episode of pulmonary thromboembolism with deep vein thrombosis. Perioperative hydrocortisone was administered. Thoracic epidural catheter was placed at T10-T11 interspace, standard general anaesthesia was administered without nitrous oxide. Patient was extubated following an uneventful procedure and discharged home on 10(th) post-operative day. Understanding the anaesthetic implications and the pathophysiological interactions of multiple metabolic disorders with a potential for multisystem involvement is key to the successful management of these patients.
对于患有两种主要代谢紊乱疾病的患者，在麻醉期间维持体内平衡是一项挑战，这两种疾病的全身效应相互补充或相互矛盾，给麻醉医生带来了难题。一名25岁患有库欣综合征且已知高同型半胱氨酸血症的男性患者计划接受开放性肾上腺切除术。这两种疾病都会加重高凝状态，且在葡萄糖代谢方面有所不同。此外，库欣综合征伴随的肥胖、困难气道、电解质和代谢紊乱值得特别关注。他曾因肺血栓栓塞伴深静脉血栓形成而接受抗凝治疗并植入下腔静脉滤器。术中给予了氢化可的松。在T10 - T11间隙放置了胸段硬膜外导管，采用不使用氧化亚氮的标准全身麻醉。手术过程顺利，术后患者于第10天拔管并出院。了解多种代谢紊乱的麻醉影响以及可能涉及多系统的病理生理相互作用是成功管理这些患者的关键。
