PARATHYROIDECTOMY
A parathyroidectomy is a surgical procedure to remove one or more of the parathyroid glands. These glands are small endocrine glands located in the neck, behind the thyroid. The procedure is typically performed to treat conditions such as hyperparathyroidism, where the parathyroid glands produce too much parathyroid hormone, leading to elevated calcium levels in the blood.
Anesthetic Implications for Parathyroidectomy
Anesthesia type: General
Airway: ETT
Preoperative:
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Parathyroid glands control serum calcium and bone calcium levels
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Serum calcium levels are important in muscle and nerve function
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Low calcium levels can cause tetany
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Nerve integrity monitor (NIM) endotracheal tube may be used (detects recurrent laryngeal nerve injury)
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If NIM ETT is used, avoid neuromuscular blockers\
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Patients may experience significant nausea secondary to hypercalcemia
Intraoperative:
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Adequacy of resection can be assessed using intraoperative PTH monitoring
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Parathyroid reimplantation may be done in the setting of total parathyroid removal
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Reimplantation: pieces of one parathyroid gland are placed in the muscle of the forearm (good blood supply)
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Reimplanted gland should be able to maintain adequate calcium levels
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Position: Supine with shoulder roll
Postoperative:
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Assess for hypocalcemia in the postoperative period
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Symptoms of hypocalcemia include tetany, paresthesias, perioral numbness, laryngospasm, seizures, and prolonged QT interval
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Hypomagnesemia aggravates hypocalcemia
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Postoperative inspiratory stridor may occur
Complications:
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Recurrent laryngeal nerve (RLN) injury
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Superior laryngeal nerve injury
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Phrenic nerve injury
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Hematoma
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Laryngeal edema
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Transient hypocalcemia
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Stridor
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Pneumothorax
Sources:
Longnecker, D. E., Brown, D. L., Newman, M. F., & Zapol, W. M. (2012). Anesthesiology, 2nd ed.
Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice.
Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.).
Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.
Vacanti, C., Segal, S., Sikka, P., & Urman, R. (Eds.). (2011). Essential Clinical Anesthesia (1st ed.)