Parathyroidectomy

Parathyroidectomy

Anesthesia type
Airway
Lines and access
Monitors
Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
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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 hyperplastic, which allow for minimally invasive parathyroidectomy. However, most procedures are still open parathyroidectomies.

Preoperative management

Patient evaluation

System	Considerations
Neurologic
Cardiovascular
Respiratory
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Patient preparation and premedication

Radioactive tracers such as methylene blue or technetium sestamibi may be administered preoperatively to facilitate detection of parathyroid glands intraoperatively.

Intraoperative management

Positioning

Supine with shoulder roll

Postoperative management

Disposition

Regular calcium levels to evaluate for postoperative hypocalcemia, which can occur in up to 15% of patients.

Potential complications

Neck hematoma is rare but can develop rapidly, resulting airway compromise. Thus it is a surgical emergency requiring prompt takeback.

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications