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Abstract
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Background and Aims Many important anaesthetic considerations are present in patients with hypothyroidism. Patients suffering from chronic alcohol misuse can present with acute deterioration, with or without concurrent illness, and necessitating intensive care. Recovery may be complicated by alcohol withdrawal. We wanted to present a case of a chronic alcoholic female patient with hypothyroidism who had to go under emergency surgery of the distal part of the humerus.
Methods A 63- year-old woman, a chronic alcoholic with poorly treated hypothyroidism was scheduled for emergency surgery due to comminuted fracture of the right distal humerus region. On the day of surgery her TSH level was 169,39 mIU/L. Also, she had surgery performed on the same arm and shoulder before already. Beacuse of her medical anamnesis we chose to perform an interscalene brachial plexus block with light sedation. Patient was given 50mcg of fentanyl and 3mg of midazolam and 600mg of propofol intravenously in total for surgery of three hours. For the block we used 10 ml of 0,5% Levobupivacaine, 5 ml of 2% Lidocaine and Dexamethsone 4 mg using ultrasound guidance.
Results The patient was breathing spontaneously the whole time. Total blood loss during surgery was 300 ml. On the ward, she was disoriented and angry in the postoperative period due to alcohol withdrawal but had no opioid requirements. In 48 hour postoperative period she was given ketoprofen 100mg and metamisol 2,5g two times on the first and second postoperative day.
Radiography scan of the distal humeral region before surgery
Radiography scan of the distal humeral region after surgery
Surgical field
Conclusions Peripheral nerve blocks are preferable for emergency surgery maintaining cardiovascular stability.