Difference between revisions of "Parathyroidectomy"
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Normal human physiology consists of four parathyroid glands. A parathyroidectomy is the removal of one or more of these glands or ectopic glands in patients who have primary hyperparathyroidism. Patients typically present with elevated calcium and associated symptoms of hypercalcemia. For most patients with hyperparathyroidism, only one gland is | Normal human physiology consists of four parathyroid glands. A parathyroidectomy is the removal of one or more of these glands or ectopic glands in patients who have primary hyperparathyroidism. Patients typically present with elevated calcium and associated symptoms of hypercalcemia. For most patients with hyperparathyroidism, only one gland is affected (single adenoma), which allow for minimally invasive parathyroidectomy. However, most procedures are still open parathyroidectomies. | ||
== Preoperative management == | == Preoperative management == | ||
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|- | |- | ||
|Neurologic | |Neurologic | ||
| | |Hypercalcemia can cause altered mental status, weakness, myalgia, and rarely seizures | ||
|- | |- | ||
|Cardiovascular | |Cardiovascular | ||
| | |Hypertension and tachycardia are common | ||
|- | |- | ||
|Respiratory | |Respiratory | ||
| | |Avoid respiratory acidosis, as this worsens hypercalcemia (less calcium bound to albumin) | ||
|- | |- | ||
|Gastrointestinal | |Gastrointestinal | ||
| | |Hypercalcemia can cause constipation, nausea/vomiting | ||
|- | |- | ||
|Hematologic | |Hematologic | ||
| Line 35: | Line 35: | ||
|- | |- | ||
|Renal | |Renal | ||
| | |Hypercalcemia can cause polyuria/polydipsia resulting in other electrolyte abnormalities. Also increased risk for nephrolithiasis | ||
|- | |- | ||
|Endocrine | |Endocrine | ||
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=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | === Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> === | ||
* EKG | |||
* CBC | |||
* BMP to evaluate calcium, magnesium, phosphate, | |||
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | === Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | ||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | === Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | ||
Radioactive tracers such as methylene blue or technetium | Patients should receive IV fluids and diuresis to control calcium levels. | ||
Radioactive tracers such as methylene blue or technetium Sestamibi may be administered preoperatively to facilitate detection of parathyroid glands intraoperatively. | |||
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | === Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | ||
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=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | === Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | ||
* Intraoperative nerve monitoring (IONM) is used by surgeon to avoid injury to recurrent laryngeal nerve | |||
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | === Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> === | ||
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | === Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> === | ||
Supine | |||
* Supine | |||
* Shoulder roll | |||
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | === Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | ||
* | |||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | === Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | ||
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=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | === Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | ||
Neck hematoma is rare but can develop rapidly, resulting airway compromise. Thus it is a surgical emergency requiring prompt takeback. | |||
* Symptomatic hypocalcemia | |||
* Neck hematoma is rare but can develop rapidly, resulting airway compromise. Thus it is a surgical emergency requiring prompt takeback. | |||
* Laryngeal nerve injury | |||
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | == Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> == | ||
Revision as of 14:23, 5 May 2021
Parathyroidectomy
| Anesthesia type | |
|---|---|
| Airway | |
| Lines and access | |
| Monitors | |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative | |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Normal human physiology consists of four parathyroid glands. A parathyroidectomy is the removal of one or more of these glands or ectopic glands in patients who have primary hyperparathyroidism. Patients typically present with elevated calcium and associated symptoms of hypercalcemia. For most patients with hyperparathyroidism, only one gland is affected (single adenoma), which allow for minimally invasive parathyroidectomy. However, most procedures are still open parathyroidectomies.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic | Hypercalcemia can cause altered mental status, weakness, myalgia, and rarely seizures |
| Cardiovascular | Hypertension and tachycardia are common |
| Respiratory | Avoid respiratory acidosis, as this worsens hypercalcemia (less calcium bound to albumin) |
| Gastrointestinal | Hypercalcemia can cause constipation, nausea/vomiting |
| Hematologic | |
| Renal | Hypercalcemia can cause polyuria/polydipsia resulting in other electrolyte abnormalities. Also increased risk for nephrolithiasis |
| Endocrine | |
| Other |
Labs and studies
- EKG
- CBC
- BMP to evaluate calcium, magnesium, phosphate,
Operating room setup
Patient preparation and premedication
Patients should receive IV fluids and diuresis to control calcium levels.
Radioactive tracers such as methylene blue or technetium Sestamibi may be administered preoperatively to facilitate detection of parathyroid glands intraoperatively.
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
- Intraoperative nerve monitoring (IONM) is used by surgeon to avoid injury to recurrent laryngeal nerve
Induction and airway management
Positioning
- Supine
- Shoulder roll
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
Regular calcium levels to evaluate for postoperative hypocalcemia, which can occur in up to 15% of patients.
Pain management
Potential complications
- Symptomatic hypocalcemia
- Neck hematoma is rare but can develop rapidly, resulting airway compromise. Thus it is a surgical emergency requiring prompt takeback.
- Laryngeal nerve injury
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
Top contributors: Tony Wang and Chris Rishel