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 hyperplastic, which allow for minimally invasive parathyroidectomy. However, most procedures are still open parathyroidectomies. | |||
== Preoperative management == | |||
=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> === | |||
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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. --> === | |||
=== 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. --> === | |||
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. --> === | |||
== Intraoperative management == | |||
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> === | |||
=== 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. --> === | |||
Supine with 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. --> === | |||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | |||
== Postoperative management == | |||
=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | |||
Regular calcium levels to evaluate for postoperative hypocalcemia, which can occur in up to 15% of patients. | |||
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management 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. | |||
== 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). --> == | |||
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== References == | |||
[[Category:Surgical procedures]] | |||
Revision as of 14:59, 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 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 |
Labs and studies
Operating room setup
Patient preparation and premedication
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
Induction and airway management
Positioning
Supine with 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
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 |
References
Top contributors: Tony Wang and Chris Rishel