Page | 1 Saudi Journal of Anesthesia Vol. 8, Issue 1, January-March 2014 Endocrine anesthesia: A rapidly evolving anesthesia specialty With ever increasing number of pre and peri-operative patients presenting for surgery with co-morbid endocrine disorders, the challenges for the anesthesiologists have grown manifold. Apart from caring for the impact of surgical pathology on endocrine functions, anesthesiologist also confronts endocrine disorders and manages their possible implications during anesthesia procedures. [1,2] DIFFERENT YET SOME COMMON BASE Though on the surface, there does not seem to be any similarity between endocrinology and anesthesiology specialties if one explores them in chthonic depth, a lot of common ground can be observed. Endocrine anesthesia (EA), an amalgam of these two medical sciences, is fast becoming a distinct specialty on its own and the present editorial aims to focus on these. ENDOCRINOLOGICAL CHALLENGES IN ANESTHESIOLOGY Anesthesia for endocrine surgery is different from that for routine procedures. Peri-operative neurotransmitter and hormonal secretion occurring with a deranged endocrinal milieu in the background can be highly variable and unpredictable. This may have a direct impact on the morbidity and mortality. In both non-endocrine and endocrine surgery, the role of pituitary, thyroid, parathyroid, pancreas, adrenal, and various other hormone releasing tissues and organs can have a direct impact on the surgical outcome. [3-7] Endocrine complications are more likely to occur in routine daily anesthesia practice in patients presenting with endocrinopathy, but may occur in all. It is therefore mandatory that an anesthesiologist should be thoroughly well-versed with all endocrine pathologies and complications, which can be encountered during surgical practice so as to “suspect,” “prevent,” “diagnose,” and “manage” them in a timely and appropriate Access this article online Quick Response Code: Website: www.saudija.org DOI: 10.4103/1658-354X.125890 manner. Hypoglycemia, hyperglycemia, hypocalcemia, hyperkalemia, hypokalemia, and many more electrolyte and metabolic abnormalities are commonly encountered in surgical patients and optimal management of these complications can greatly help in achieving a better surgical outcome. [8,9] ANESTHETIC TECHNIQUE: A DIFFICULT CHOICE The choice of anesthesia is also determined by pathophysiological alterations due to different endocrinopathies related to pancreas, thyroid, parathyroid, adrenal, pituitary, and others. [3-7] Autonomic function and integrity is of utmost importance while formulating the plan of anesthesia. As autonomic dysfunction is commonly encountered in many of the endocrine disorders such as diabetes, adrenal disease, and other, pre-operative assessment and intra-operative vigilance is important. [3-7,10] Equally, crucial is the assessment of cardiovascular status, neuro-muscular functions, renal parameters and various other organ systems, which are directly or indirectly affected by various endocrinopathies. ENDOCRINOPATHIES IN ANESTHESIA AND CRITICAL CARE The modern day anesthesiologist has to look after intensive care services as well. Occurrence of co-morbid endocrinopathies does impact the management and prognosis of critically ill patients. Timely detection and management of endocrinopathies in such patients can be life-saving. [9-12] Often, patients are either primarily admitted with uncontrolled diabetes and/or its related complications of diabetes may present as a major co-morbidity during such hospitalization. Similarly, many other endocrine and metabolic disorders may necessitate critical care admissions or are diagnosed for the first time during admission only. [3-7,13-15] Still, many new endocrinopathies and metabolic disorders develop de novo during the course of treatment either due to infections and drug effects/interaction or can arise as a complication of various therapeutic procedures such as de novo endocrinopathy: Acute hypoparathyroidism after thyroid surgery; hypopituitarism after pituitary surgery; longterm Nelson’s syndrome after adrenal surgery; diabetes after transplant new onset diabetes after transplantation (NODAT) and many more. [3-8] EDITORIAL [Downloaded free from http://www.saudija.org on Sunday, February 02, 2014, IP: 117.214.210.255] || Click here to download free Android application for