title: Transient increases in intraoperative parathyroid levels related to anesthetic technique.
abstract: BACKGROUND
  Parathyroid hormone (PTH) secretion is partially regulated by circulating catecholamines. We examined the effect of different anesthetic techniques on intraoperative PTH (IOPTH) levels in patients undergoing parathyroidectomy for primary hyperparathyroidism.
  
  
  METHODS
  We prospectively studied 132 patients divided into 3 anesthetic cohorts: monitored anesthetic care (MAC; n = 45), general anesthesia with laryngeal mask airway (LMA; n = 43), or general endotracheal anesthesia (GETA; n = 39). IOPTH levels were drawn before induction and at defined intervals postinduction.
  
  
  RESULTS
  All anesthetic techniques increased IOPTH levels from preinduction to 3 minutes postinduction (MAC, 28%; LMA, 45%; GETA, 65%; P < .001). Temporal trends in postinduction IOPTH levels were similar in patients receiving general anesthesia, characterized by a peak effect at 6 minutes. Using a multivariate logistic regression analysis, GETA was >7 times more likely to increase the preinduction IOPTH by ≥ 50% at 3 minutes postinduction compared with MAC (P < .0001). Using immediate postinduction IOPTH levels in surgical decision making would have led to failed surgery in 2 of 6 patients with multiple gland disease receiving GETA.
  
  
  CONCLUSIONS
  Preincision IOPTH samples should be drawn before induction to avoid incorporation of potentially misleading anesthetic-related IOPTH elevations into surgical decision making.
authors.affiliation: Department of Anesthesiology, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA.
authors.forename: Joe C
authors.initials: JC
authors.lastname: Hong
authors.forename: Lilah F
authors.initials: LF
authors.lastname: Morris
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Park
authors.forename: Philip H G
authors.initials: PH
authors.lastname: Ituarte
authors.forename: Christine H
authors.initials: CH
authors.lastname: Lee
authors.forename: Michael W
authors.initials: MW
authors.lastname: Yeh
mesh_terms: D000770:Anesthesia, Endotracheal; D000768:Anesthesia, General / Q000379:methods*; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000601:surgery*; D007432:Intraoperative Period; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D015999:Multivariate Analysis; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D010281:Parathyroid Hormone