Perioperative Complications of Endocrine Diseases

Post-operative care represents an important aspect of critical care medicine. In multi-specialty practices, a team approach is often used to optimize the care of critical and post-operative patients. Endocrine surgery is routinely performed and may be accompanied by unique post-operative concerns. Especially as it relates to surgery involving the pancreas and the adrenal gland, anticipation of potentially life-threatening complications is required for a successful outcome.

Surgery related to the pancreas
Surgical manipulation of the pancreas is generally approached with caution due to the potential of compromising the blood supply and inducing postoperative pancreatitis. Pancreatic surgery is most commonly performed in dogs with pancreatic masses. Retrospective studies of dogs with insulinomas have shown a survival benefit to surgical resection over medical management, as well as confirmation of diagnosis, staging, and overall reduction of gross disease. Preoperatively glucose control can be challenging, with the major goal of stabilizing glucose concentration in a range that does not cause clinical signs of hypoglycemia. In severe cases, glucagon may be used to raise blood glucose and avoid clinical signs of hypoglycemia. Glucose supplementation may precipitate a hypoglycemic crisis. Despite gentle manipulation, intra-operative manipulation of the pancreas may trigger insulin release and worsening hypoglycemia. For this reason, blood glucose should be monitored frequently throughout surgery and at regular intervals post-operatively. Dextrose is administered in those patients with worsening hypoglycemia and maintained during the post-operative period until the dog is eating. Techniques used to raise blood glucose in those dogs showing clinical signs of hypoglycemia that are refractory to glucose supplementation include the following:

• Glucagon infusion (5-40ng/kg/min)
• Glucocorticoids (dexamethasone 0.3mg/kg IV)
• Diazoxide (6.6-40mg/kg/day divided)

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