A patient with recently diagnosed hypothyroidism requires an emergency surgical procedure. Which of the following risks of anesthesia is MOST likely to be increased in this patient?
Hypothyroidism is a common and often underdiagnosed comorbidity. Most patients with chronic hypothyroidism will be receiving thyroid replacement therapy, which acts over long periods to maintain thyrotropin (T3) at a normal level. There are minimal additional risks of anesthesia in this population.
Of greater concern is the emergency patient with unrecognized or newly diagnosed hypothyroidism who must undergo surgery without adequate preoperative replacement therapy. The largest anesthesia risk in these patients is oversedation, as they are highly sensitive to the mental-status and respiratory-depressant effects of anesthetics. Sedative premedication should be given cautiously or not at all, and the patient should be monitored closely before entering the OR. Postoperatively, the patient should be allowed additional time to emerge from anesthesia before extubation and transport...
