Parathyroidectomy - Revision history

Dominicmangino: Added details to procedure variant table from JAFFE as well as to positioning

2025-08-02T23:37:04Z

Added details to procedure variant table from JAFFE as well as to positioning

← Older revision		Revision as of 16:37, 2 August 2025
Line 76:		Line 76:
	*Supine		*Supine
	* Shoulder roll		* Shoulder roll
			*Reverse Trendelenburg or 30 degree HOB elevation
			*Head in Gel donut

	=== 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. -->===
Line 104:		Line 106:
	\|+		\|+
	!		!
	! ~~Variant 1~~		! Open
	!~~Variant 2~~		!Minimally invasive (endoscopic)
			!Minimally invasive (robotic)
	\|-		\|-
	\|Unique considerations		\|Unique considerations
			\|
	\|		\|
	\|		\|
	\|-		\|-
	\|Position		\|Position
			\|Supine; shoulder roll; reverse Trendelenberg, headrest with gel donut
	\|		\|
	\|		\|
	\|-		\|-
	\|Surgical time		\|Surgical time
			\|1-2h
	\|		\|
	\|		\|
	\|-		\|-
	\|EBL		\|EBL
			\|25-50mL
	\|		\|
	\|		\|
	\|-		\|-
	\|Postoperative disposition		\|Postoperative disposition
			\|PACU to either med surg for Ca monitoring x 24 hours, or PACU to home
	\|		\|
	\|		\|
	\|-		\|-
	\|Pain management		\|Pain management
	\|		\|3-4
	\|		\|Less than open
			\|less than open
	\|-		\|-
	\|Potential complications		\|Potential complications
			\|Hypocalcemia: <15%

			Hypoparathyroidism: <5%

			Hematoma: 1%

			Infection: 1%

			Recurrent laryngeal paralysis: <1%
	\|		\|
	\|		\|

Tony.Wang: Added nerve monitoring and remi

2022-06-29T14:42:51Z

Added nerve monitoring and remi

← Older revision		Revision as of 07:42, 29 June 2022
Line 8:		Line 8:
	Neuromonitoring		Neuromonitoring
	\| considerations_preoperative =		\| considerations_preoperative =
	\| considerations_intraoperative =		\| considerations_intraoperative = Relaxation with remifentanil if neuro monitoring
	\| considerations_postoperative = Hypocalcemia		\| considerations_postoperative = Hypocalcemia
	Recurrent laryngeal nerve palsy		Recurrent laryngeal nerve palsy
Line 68:		Line 68:

	===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. -->===

			* NIMS endotracheal tube is used for recurrent laryngeal nerve monitoring
			* Preferably use video laryngoscope so surgery team can confirm lead placement

	=== 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. -->===
Line 76:		Line 79:
	=== 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. -->===

	*		*Avoid paralytic for nerve monitoring. Consider remifentanil instead.

	=== 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. -->===

			* Ensure smooth emergence with minimal coughing/bucking, as this can cause neck bleeding
			** Consider leaving remifentanil on (around 0.05 mcg/kg/min) or extubating deep.

	==Postoperative management==		==Postoperative management==

Chris.Rishel at 06:45, 5 April 2022

2022-04-05T06:45:43Z

← Older revision		Revision as of 23:45, 4 April 2022
Line 10:		Line 10:
	\| considerations_intraoperative =		\| considerations_intraoperative =
	\| considerations_postoperative = Hypocalcemia		\| considerations_postoperative = Hypocalcemia
	~~RLN~~ palsy		Recurrent laryngeal nerve palsy
	}}A '''parathyroidectomy''' is the removal of one or more of the parathyroid 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.		}}A '''parathyroidectomy''' is the removal of one or more of the parathyroid 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.

Chris.Rishel at 06:42, 5 April 2022

2022-04-05T06:42:33Z

← Older revision		Revision as of 23:42, 4 April 2022
Line 1:		Line 1:
	{{Infobox surgical case reference		{{Infobox surgical case reference
	\| anesthesia_type =		\| anesthesia_type = General
	\| airway =		\| airway = Neuromonitoring ETT
	\| lines_access =		\| lines_access = PIV
	\| monitors =		\| monitors = Standard
			5-lead ECG
			Temperature
			Neuromonitoring
	\| considerations_preoperative =		\| considerations_preoperative =
	\| considerations_intraoperative =		\| considerations_intraoperative =
	\| considerations_postoperative =		\| considerations_postoperative = Hypocalcemia
			RLN palsy
	}}A '''parathyroidectomy''' is the removal of one or more of the parathyroid 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.		}}A '''parathyroidectomy''' is the removal of one or more of the parathyroid 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.

Chris.Rishel: Text replacement - "|Respiratory" to "|Pulmonary"

2022-02-22T05:45:15Z

Text replacement - "|Respiratory" to "|Pulmonary"

← Older revision		Revision as of 22:45, 21 February 2022
Line 23:		Line 23:
	\|Hypertension and tachycardia are common		\|Hypertension and tachycardia are common
	\|-		\|-
	\|~~Respiratory~~		\|Pulmonary
	\|Avoid respiratory acidosis, as this worsens hypercalcemia (less calcium bound to albumin)		\|Avoid respiratory acidosis, as this worsens hypercalcemia (less calcium bound to albumin)
	\|-		\|-

Chris.Rishel at 09:40, 9 July 2021

2021-07-09T09:40:28Z

← Older revision		Revision as of 02:40, 9 July 2021
Line 7:		Line 7:
	\| considerations_intraoperative =		\| considerations_intraoperative =
	\| considerations_postoperative =		\| considerations_postoperative =
	}}		}}A '''parathyroidectomy''' is the removal of one or more of the parathyroid 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.

	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 ==~~		===Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. -->===

	=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
	{\| class="wikitable"		{\| class="wikitable"
	\|+		\|+
	!System		! System
	!Considerations		!Considerations
	\|-		\|-
Line 28:		Line 26:
	\|Avoid respiratory acidosis, as this worsens hypercalcemia (less calcium bound to albumin)		\|Avoid respiratory acidosis, as this worsens hypercalcemia (less calcium bound to albumin)
	\|-		\|-
	\|Gastrointestinal		\| Gastrointestinal
	\|Hypercalcemia can cause constipation, nausea/vomiting		\|Hypercalcemia can cause constipation, nausea/vomiting
	\|-		\|-
Line 44:		Line 42:
	\|}		\|}

	=== 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		*EKG
	* CBC		*CBC
	* BMP to evaluate calcium, magnesium, phosphate,		*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. -->===
	Patients should receive IV fluids and diuresis to control calcium levels.		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.		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. --> ===

	== Intraoperative management ==		==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. --> ===		=== 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		*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		* 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. -->===

	== Postoperative management ==		==Postoperative management==

	=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===		===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.		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. --> ===		===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. --> ===		===Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===

	* Symptomatic hypocalcemia		* Symptomatic hypocalcemia
	* Neck hematoma is rare but can develop rapidly, resulting airway compromise. Thus it is a surgical emergency requiring prompt takeback.		*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		*Recurrent laryngeal nerve injury, if unilateral, results in a hoarse voice, but if bilateral, can result in obstructed airway requiring emergent tracheostomy

	== 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). --> ==

	{\| class="wikitable"		{\| class="wikitable"
	\|+		\|+
	!		!
	!Variant 1		! Variant 1
	!Variant 2		!Variant 2
	\|-		\|-
Line 128:		Line 126:
	\|}		\|}

	== References ==		==References==

	[[Category:Surgical procedures]]		[[Category:Surgical procedures]]
			[[Category:General surgery]]
			[[Category:Endocrine surgery]]

Tony.Wang: Complication clarification

2021-05-05T22:34:00Z

Complication clarification

← Older revision		Revision as of 15:34, 5 May 2021
Line 89:		Line 89:
	* Symptomatic hypocalcemia		* Symptomatic hypocalcemia
	* Neck hematoma is rare but can develop rapidly, resulting airway compromise. Thus it is a surgical emergency requiring prompt takeback.		* Neck hematoma is rare but can develop rapidly, resulting airway compromise. Thus it is a surgical emergency requiring prompt takeback.
	* ~~Laryngeal~~ nerve injury		* Recurrent laryngeal nerve injury, if unilateral, results in a hoarse voice, but if bilateral, can result in obstructed airway requiring emergent tracheostomy

	== 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). --> ==

Tony.Wang at 22:23, 5 May 2021

2021-05-05T22:23:27Z

← Older revision		Revision as of 15:23, 5 May 2021
Line 9:		Line 9:
	}}		}}

	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.		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 ==
Line 20:		Line 20:
	\|-		\|-
	\|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
Line 45:		Line 45:

	=== 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 ~~sestamibi~~ may be administered preoperatively to facilitate detection of parathyroid glands intraoperatively.		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. --> ===
Line 56:		Line 62:

	=== 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 ~~with shoulder~~ roll
			* 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. --> ===
Line 74:		Line 86:

	=== 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). --> ==

Tony.Wang: Putting in the basics

2021-05-05T21:59:04Z

Putting in the basics

← Older revision		Revision as of 14:59, 5 May 2021
Line 1:		Line 1:
	.		{{Infobox surgical case reference
			\| anesthesia_type =
			\| airway =
			\| lines_access =
			\| monitors =
			\| considerations_preoperative =
			\| considerations_intraoperative =
			\| considerations_postoperative =
			}}

			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. --> ===
			{\| class="wikitable"
			\|+
			!System
			!Considerations
			\|-
			\|Neurologic
			\|
			\|-
			\|Cardiovascular
			\|
			\|-
			\|Respiratory
			\|
			\|-
			\|Gastrointestinal
			\|
			\|-
			\|Hematologic
			\|
			\|-
			\|Renal
			\|
			\|-
			\|Endocrine
			\|
			\|-
			\|Other
			\|
			\|}

			=== 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). --> ==

			{\| class="wikitable"
			\|+
			!
			!Variant 1
			!Variant 2
			\|-
			\|Unique considerations
			\|
			\|
			\|-
			\|Position
			\|
			\|
			\|-
			\|Surgical time
			\|
			\|
			\|-
			\|EBL
			\|
			\|
			\|-
			\|Postoperative disposition
			\|
			\|
			\|-
			\|Pain management
			\|
			\|
			\|-
			\|Potential complications
			\|
			\|
			\|}

			== References ==

			[[Category:Surgical procedures]]

Tony.Wang at 21:16, 5 May 2021

2021-05-05T21:16:18Z

← Older revision	Revision as of 14:16, 5 May 2021
Line 1:	Line 1:
		.