Anesthetic Management of Secondary Hyperparathyroidism

This report describes the anesthetic management of a male, 54-year old patient with the secondary hyperparathyroidism. The patient had a long history of chronic renal failure which required hemodialysis and developed secondary hyperparathyroidism. On the day before operation hemodialysis was performed to maintain serum electrolyte concentration within normal levels. Anesthesia was induced with thiopental and was maintained with nitrous oxide-halothane in oxygen. A half of routine dose of pancuronium facilitated endotracheal intubation, and thereafter no muscular blocking agent was administered. Hypotension of 60mmHg (systolic blood pressure) which occurred 3 hours after the start of operation was successfully treated with volume loading and dopamine infusion. After the operation his respiratory condition was satisfactory. Transient postoperative hyperpotassemia was observed and treated by hemodialysis. Calcium concentration declined to 3.0mEq/L on the first postoperative day and thereafter remained at subnormal levels. However, there was no clinical evidence of hypocalcemia.