Perioperative metabolism in patients with secondary hyperparathyroidism and methods of its correction

Abstract

It is important to study changes in metabolism in patients with secondary hyperparathyroidism (SHPT) during parathyroid surgical interventions (PTSI), as well as to search for ways to correct them. Aim. To study metabolism in patients with SHPT with PTSI and assess the possibilities of its correction. Materials and methods. The study was prospective, not randomized. We studied 135 patients with SHPT with end-stage chronic renal failure who underwent PTSI (72 men and 63 women, aged from 19 to 73 years). Preoperative risk ASA III–IV. General anesthesia using the inhalation anesthetic sevoflurane and the narcotic analgesic fentanyl in low-flow mechanical ventilation. Operational monitoring was complemented by the use of indirect calorimetry. In group I (n = 70), the metabolic rate (MR) and basal metabolism rate (BMR) were determined against the background of standard intensive therapy. In group II (n = 65) – target metabolic rate (TMR) and the metabolic disorders (MD) were additionally determined, and intensive therapy was supplemented with glucocorticoids. Results. The baseline MR in both groups were low, close to BMR. The MR of patients in group I remained low during the entire PTSI (P < 0.05). In group II, from the stage of removal of the parathyroid glands, a steady increase in the MR, with a significant excess of the baseline MR and BMR (P < 0.05), was noted. TMR decreased while exceeding the MR. Group II patients woke up and were transferred to the ward faster compared to group I, and nausea and vomiting were 2.5 times less frequent (9.2 % in group II, 22.9 % in group I). 12 hours after PTSI, feeling of pain, according to the VAS scale, was lower than in group I (P < 0.05). During the day after PTSI, the indicators of the acid-base state of the venous blood of both groups did not change significantly, and the level of ionized calcium decreased (P < 0.05), which required additional intravenous administration of 10 % calcium gluconate. Conclusions. Perioperative energy monitoring makes it safer to carry out PTSI in patients with SHPT. Additional definition of the TMR and the MD allows for more efficient construction of intensive therapy.