Turkish Journal of
GERIATRICS

Dokuz Eylül Üniversitesi Tıp Fakültesi Anesteziyoloji ve Reanimasyon Anabilim Dalı, İzmir
Dokuz Eylül Üniversitesi Tıp Fakültesi Anesteziyoloji ve Reanimasyon Anabilim Dalı, Öğr.Gör., Uzm.Dr.,İzmir
Dokuz Eylül Üniversitesi Tıp Fakültesi Anesteziyoloji ve Reanimasyon Anabilim Dalı, Yrd.Doç. Dr., İzmir Hypothyroidism is a serious co-existing disease in the perioperative course, which is often overlooked in geriatric population, since its signs are attributed to aging. Our aim is to present our anesthetic experience in a case undergoing major surgery that hypothyroidism is first noticed in the preoperative anesthetic evaluation. A 78 year-old woman was diagnosed as pancreatic tumor and was scheduled for pancreaticoduodenectomy. In her medical history, paroxysmal atrial tachycardia, hypertension and coronary artery disease were present. In her physical examination hypothyroidism was suspected because her dry and shabby hair, weakness, depression, and thin dry skin. Laboratory analysis confirmed the diagnosis. In the operating room, an epidural catheter was inserted and epidural anesthesia was achieved at the T6 level with bupivacaine 0. 5 % 2 ml + fentanyl 1 ml + normal saline 2 ml. General anesthesia was inducted with thiopental 100 mg, fentanyl 50 mg, vecuronium 5 mg and maintained with sevoflurane 0.3-0.5 %inspiratory concentration in 50% O2 + N2O mixture and 2ml/h epidural infusion of bupivacaine 0.125 % with fentanyl 2 mg/ml. At the and of the surgery, the patient was extubated in the operating room and was followed up for one day in the ntensive care unit then transferred to the ward. The postoperative epidural analgesia was provided for three days. The preoperative anesthetic evaluation becomes more important in geriatric patients for the determination of the perioperative management. By considering that any perioperative problem was not occurred in our patient, it can be suggested that general combined with epidural anesthesia using minimum drug dosages is a reasonable technique for these patients. Keywords : Geriatrics, Hypothyroidism; Anesthesia, General; anesthesia, Epidural