[Prolonged post-anesthesia recovery in hemodialysis-induced hypothyroidism].
We report about a 30-year-old female patient with terminal renal failure, undergoing allogenic renal-transplantation after two and a half years on hemodialysis. Besides, the preoperative examination seemed normal. The intraoperative phase was uneventful, except a transfusion-requiring blood-loss of 2000 ml, and the graft started diuresis immediately after reperfusion. Postoperatively the duration of the non-depolarising muscle-relaxant atracurium was prolonged for more than one hour and a deep sedation, caused by the premedication-benzodiazepine Dipotassiumchlorazepat, was seen. Unless antagonisation, the patient was unconscious for some hours. Laboratory evaluation showed peripheral hypothyroidism with normal pituitary activity: T(3)0.8 ng/ml, T(4)3.9 micrograms/dl und TSH 0.67 microU/ml. Under temporary substitution with L-Thyroxine 50 micrograms, the patient recovered quickly an could be demitted after 10 days. Further controls showed euthyroidism. 14 month later, she underwent an antirefluxive surgical procedure, at excellent graft-function. Anesthesia was uneventful that time.
Nibler
R
R
Institut für Anästhesiologie, Klinikum Grosshadern der LMU München.
Weninger
E
E
Illner
W D
WD
D000328:Adult; D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation; D001279:Atracurium; D003009:Clorazepate Dipotassium; D005260:Female; D018757:GABA Modulators; D006801:Humans; D007037:Hypothyroidism / Q000188:drug therapy / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000628:therapy; D016030:Kidney Transplantation; D003473:Neuromuscular Nondepolarizing Agents; D006435:Renal Dialysis / Q000009:adverse effects*; D013974:Thyroxine / Q000627:therapeutic use
D018757:GABA Modulators; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D003009:Clorazepate Dipotassium; D013974:Thyroxine