Anaesthetic management of primary hyperparathyroidism with hypercalcaemia and multiple bone fractures for excision of parathyroid adenoma.

Abstract

Calcium is important for maintaining numerous physiological processes many of which are important for anaesthesiologists. Primary hyperparathyroidism is an important cause of hypercalcemia, and can be associated with multitude of systemic problems. Our patient presented with severe hyperparathyroidism with hypercalcemia, multiple bone fractures and deformities and was planned for excision of parathyroid adenoma. Management of hypercalcaemia was initiated preoperarively and was continued in intra-operative period. Meticulous attention was paid on patient positioning and prevention of further bone fractures. We used Dexmedetomidine to supplement anaesthetic agents, to facilitate smooth recovery and to prevent post-operative shivering. Close monitoring of ECG and neuromuscular function was done. Vigilant monitoring was done to detect possible postoperative complications, including hypocalcaemia. We present this case to discuss the complexity of problems that primary hyperparathyroidism can manifest and the related anaesthetic concerns.