Perioperative management of a patient with primary hypoparathyroidism and severe hypocalcaemia for lumbar spine surgery

Deepak Madankar; Sheetal Samel; Abhay Ganar; Neelesh Mathankar

doi:10.4103/2348-0548.173253

Journal of Neuroanaesthesiology and Critical Care, Table of Contents

CC-BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2016; 03(01): 049-051
DOI: 10.4103/2348-0548.173253

Case Report

Thieme Medical and Scientific Publishers Private Ltd.

Perioperative management of a patient with primary hypoparathyroidism and severe hypocalcaemia for lumbar spine surgery

Authors

Deepak Madankar

¹Department of Anaesthesiology, Meditrina Institute of Medical Sciences, Nagpur, Maharashtra, India
Sheetal Samel

¹Department of Anaesthesiology, Meditrina Institute of Medical Sciences, Nagpur, Maharashtra, India
Abhay Ganar

¹Department of Anaesthesiology, Meditrina Institute of Medical Sciences, Nagpur, Maharashtra, India
Neelesh Mathankar

¹Department of Anaesthesiology, Meditrina Institute of Medical Sciences, Nagpur, Maharashtra, India

Abstract

Primary hypoparathyroidism and consequent hypocalcaemia in the absence of iatrogenic cause are a rare entity. Serum ionised calcium concentrations < 0.50 mmol l⁻¹ are more frequently associated with life-threatening complications and constitute a medical emergency that necessitates intravenous calcium therapy. The anaesthesiologist should carefully look for the effects of hypocalcaemia on the heart, circulation, muscle power and blood coagulation. We report perioperative management of a case of hypoparathyroidism and associated hypocalcaemia posted for lumbar discectomy in prone position and its anaesthetic implications.

Keywords

Anaesthesia - hypocalcaemia - life-threatening complications - primary hypoparathyroidism - spine surgery

Full Text

References

REFERENCES
1 Murphy E, Williams GR. Hypocalcaemia. Medicine 2009; 37: 465-8
2 Khan A, Bilezikian J. Primary hyperparathyroidism: Pathophysiology and impact on bone. CMAJ 2000; 163: 184-7
3 Fong J, Khan A. Hypocalcemia: Updates in diagnosis and management for primary care. Can Fam Physician 2012; 58: 158-62
4 Cooper MS, Gittoes NJ. Diagnosis and management of hypocalcaemia. BMJ 2008; 336: 1298-302
5 Aguilera IM, Vaughan RS. Calcium and the anaesthetist. Anaesthesia 2000; 55: 779-90
6 Shoback D. Clinical practice. Hypoparathyroidism. N Engl J Med 2008; 359: 391-403
7 Roizen MF, Fleisher LA. Anesthetic implications of concurrent diseases. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL. editors. Miller's Anesthesia. 7th ed.. Philadelphia: Churchill Livingstone; 2010. p. 1067-150
8 Urbano FL. Signs of hypocalcemia: Chvostek's and Trousseau's signs. Hosp Physician 2000; 36: 43-5
9 Schonberger RB. Fluid electrolyte and acid base disorders. In: Stoelting RK, Hines RL, Marschall KE. editors. Stoelting's Anesthesia and Co-existing Disease. 6th ed.. Philadelphia: Elsevier Health Sciences; 2012. p. 357-75
10 Maeda SS, Fortes EM, Oliveira UM, Borba VC, Lazaretti-Castro M. Hypoparathyroidism and pseudohypoparathyroidism. Arq Bras Endocrinol Metabol 2006; 50: 664-73
11 Tohme JF, Bilezikian JP. Diagnosis and treatment of hypocalcemic emergencies. Endocrinologist 1996; 6: 10-8
12 Zaloga GP, Chernow B. Hypocalcemia in critical illness. JAMA 1986; 256: 1924-9