MetroHealthAnesthesiaAnesthesia and Hypoparathryroidism

Clinical Manirestations
    Usually follows parathyroidectomy
    Manifestations (of hypocalcemia)
    • Cardiovascular
        hypotension
        CHF
        ECG changes (prolonged QT interval)
    • Musculoskeletal
        muscle cramps
        weakness
    • Neurologic
        neuromuscular irritability
          laryngospasm
          inspiratory stridor
          tetany
          seizures
          Chvostek's sign
            facial nerve tap -> face twitches painfully
          Trousseau's sign
            tourniquet for 3 minutes -> carpopedal spasm
        perioral paresthesia
        mental status changes
          dementia
          depression
          psychosis
    Other causes of hypocalcemia
      renal failure
      hypomagnesemia
      vitamin D deficiency
      acute pancreatitis
    Treatment of symptomatic hypocalcemia
      calcium chloride IV slow
Anesthetic Considerations
  • CaCl2 to normalize Ca if cardiac manifestations
  • Avoid hyperventilation (or sodium bicarbonate) which will decrease ionized Ca level
  • Beware citrate-containing blood products (decrease Ca level)
  • Avoid 5% albumin (may lower ionized Ca level)
  • May be more sensitive to neuromuscular blocking drugs



Send Comments to Greg Gordon MD, gjg@po.cwru.edu
Department of Anesthesiology
The MetroHealth System
2500 MetroHealth Drive
Cleveland, Ohio 44109-1998
Phone: (216) 778-4801
Last updated: