|Lines and access|
|Primary anesthetic considerations|
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.
|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|
|Renal||Hypercalcemia can cause polyuria/polydipsia resulting in other electrolyte abnormalities. Also increased risk for nephrolithiasis|
Labs and studies
- 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
Monitoring and access
- Intraoperative nerve monitoring (IONM) is used by surgeon to avoid injury to recurrent laryngeal nerve
Induction and airway management
- Shoulder roll
Maintenance and surgical considerations
Regular calcium levels to evaluate for postoperative hypocalcemia, which can occur in up to 15% of patients.
- Symptomatic hypocalcemia
- Neck hematoma is rare but can develop rapidly, resulting airway compromise. Thus it is a surgical emergency requiring prompt takeback.
- Recurrent laryngeal nerve injury, if unilateral, results in a hoarse voice, but if bilateral, can result in obstructed airway requiring emergent tracheostomy
|Variant 1||Variant 2|