Anaesthetic Approach in a Case with Hypothyroidis

Abstract

In anaesthesia practice, patients with thyroid gland and the other endocrine pathologies are frequently experienced. Multiple organs as well as cardiovascular system are influenced in patients with thyroid gland dysfunction during the urgent surgery. We aimed to present our anaesthetic experience for orthopaedic surgery in a case whose hypothyroidism had been recognised initially during preoperative assessment. In a 48-year-old male patient, an orthopaedic surgery was scheduled for the right ankle lateral malleolar dislocation fracture result from falling into home. His medical history was unremarkable. On the physical examination; general condition was good, consciousness was open. He was cooperated but depressed. Skin was cold, dry and rough. Also, there was the rough face appearance, enlarged tongue and swelling around the eyes. According the preoperative evaluation, TSH was >100 ulU/ml, free T4 was <0.04 ng/dl and free T3 was 1.30 pg/ml. Without premedication usage, a spiral needle was inserted at once to subarachnoid gap within range of L4-5 on the right lateral position. 0.5 % hyperbaric bupivacaine of 10 mg (2 ml) was given following free CSF outflow. Surgery started when sensorial block was reach to T10 level. No any cardiovascular or respiratory complication was seen during the about 1.5-hour surgery or one-hour postoperative period. The patient was assessed by internal medicine department and polyclinic control was recommended. Then, the patient was discharged on the fourth day of surgery. As a conclusion, we suggest that if surgical region is suitable, spinal anaesthesia implemented with low dose local anaesthetic agent may be a safety method in hypothyroidic cases needed urgent surgery to not wait for euthyroidic condition.