Thyroidectomy - Revision history

Tony.Wang at 03:27, 27 June 2024

2024-06-27T03:27:16Z

← Older revision		Revision as of 20:27, 26 June 2024
Line 55:		Line 55:

	=== 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. --> ===

			* NIM tube for intraop vocal cord nerve stimulation
			* Video scope for NIM tube placement

	=== 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. --> ===
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	=== 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 (for neuro monitoring)		* NIM endotracheal tube (for neuro monitoring)
	* Video laryngoscope for surgeons to ensure proper electrode placement		* Video laryngoscope for surgeons to ensure proper electrode placement
			*Succinylcholine or remifentanil bolus (up to 4 mcg/kg) for intubating conditions

	=== 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. --> ===
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	=== 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 paralysis		* Avoid paralysis for nerve monitoring
	* Consider remifentanil instead of paralytic agents, (0.05-0.2mcg/kg/min typically throughout the case)		* Consider remifentanil instead of paralytic agents, (0.05-0.2mcg/kg/min typically throughout the case)

	=== 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. --> ===

	* Avoid bucking/coughing		* Avoid bucking/coughing as this can lead to neck hematoma
	** Consider deep extubation		** Consider deep extubation
	** Consider leaving ~~remi~~ on		** Consider leaving remifentanil on (~0.05 mcg/kg/min) until extubation

	== Postoperative management ==		== Postoperative management ==
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	* Pain is worse with minimally invasive transoral approach.		* Pain is worse with minimally invasive transoral approach.
	* Usually can be managed with ~~tylenol~~ and oral opioids in PACU, can consider IV opioids as backup		* Usually can be managed with Tylenol and oral opioids in PACU, can consider IV opioids as backup

	=== 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. --> ===

Tony.Wang at 03:23, 27 June 2024

2024-06-27T03:23:14Z

← Older revision		Revision as of 20:23, 26 June 2024
Line 78:		Line 78:

	* Supine		* Supine
	*~~Some~~ rotate the bed 180 degrees		*ENT surgeons tend to rotate the bed 90 or 180 degrees. Surgical oncologists tend to avoid rotating.

	=== 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. --> ===

Oliviamsutton at 20:36, 24 October 2022

2022-10-24T20:36:06Z

← Older revision		Revision as of 13:36, 24 October 2022
Line 6:		Line 6:
	5-lead ECG		5-lead ECG
	Neuromonitoring		Neuromonitoring
	\| considerations_preoperative =		\| considerations_preoperative = Potential for tracheal compression, deviation due to mass effect creating difficult airway
	\| considerations_intraoperative =		\| considerations_intraoperative = Avoiding paralytic due to RLN monitoring
	\| considerations_postoperative = Hypocalcemia		\| considerations_postoperative = Hypocalcemia
	Recurrent laryngeal nerve palsy		Recurrent laryngeal nerve palsy
Line 60:		Line 60:

	=== 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. --> ===
	~~N/A~~
			* Surgeon may be able to infiltrate the site with local

	== Intraoperative management ==		== Intraoperative management ==
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	* Supine		* Supine
			*Some rotate the bed 180 degrees

	=== 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 paralysis		* Avoid paralysis
	* Consider remifentanil instead		* Consider remifentanil instead of paralytic agents, (0.05-0.2mcg/kg/min typically throughout the case)

	=== 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. --> ===
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	=== 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. --> ===

			* Pain is worse with minimally invasive transoral approach.
			* Usually can be managed with tylenol and oral opioids in PACU, can consider IV opioids as backup

	=== 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. --> ===
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	\|+		\|+
	!		!
	!~~Variant 1~~		!Open thyroidectomy
	!~~Variant 2~~		!Transoral thyroidectomy (minimally invasive)
	\|-		\|-
	\|Unique considerations		\|Unique considerations
	\|~~Open thyroidectomy~~		\|
	\|~~Transoral thyroidectomy (minimally invasive)~~		\|
	\|-		\|-
	\|Position		\|Position
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	\|-		\|-
	\|Pain management		\|Pain management
	\|		\|Pain is less significant
	\|		\|Pain is worse, consider giving long acting opioid during the case
	\|-		\|-
	\|Potential complications		\|Potential complications

Tony.Wang: created page

2022-06-29T15:41:51Z

created page

← Older revision		Revision as of 08:41, 29 June 2022
Line 22:		Line 22:
	\|-		\|-
	\|Airway		\|Airway
	\|		\|Large goiter can compress airway or cause vocal cord paralysis
	\|-		\|-
	\|Neurologic		\|Neurologic
Line 28:		Line 28:
	\|-		\|-
	\|Cardiovascular		\|Cardiovascular
	\|		\|Tachycardia, tachyarrhythmias
	\|-		\|-
	\|Pulmonary		\|Pulmonary
Line 43:		Line 43:
	\|-		\|-
	\|Endocrine		\|Endocrine
	\|		\|Thyroid storm
	\|-		\|-
	\|Other		\|Other
Line 50:		Line 50:

	=== 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. --> ===

			* Thyroid studies
			* BMP

	=== 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. --> ===
			N/A

	=== 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. --> ===
			N/A

	== 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. --> ===

			* Standard ASA monitors
			* IONM (intra operative nerve monitoring) for 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. --> ===

			* NIMS endotracheal tube (for neuro monitoring)
			* Video laryngoscope for surgeons to ensure proper electrode 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. --> ===

			* Supine

	=== 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 paralysis
			* 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. --> ===

			* Avoid bucking/coughing
			** Consider deep extubation
			** Consider leaving remi on

	== 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. --> ===

			* PACU, stay in hospital

	=== 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. --> ===
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	* 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
			*Hypocalcemia

	== 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). --> ==

Chris.Rishel at 06:45, 5 April 2022

2022-04-05T06:45:56Z

← Older revision		Revision as of 23:45, 4 April 2022
Line 8:		Line 8:
	\| considerations_preoperative =		\| considerations_preoperative =
	\| considerations_intraoperative =		\| considerations_intraoperative =
	\| considerations_postoperative = ~~RLN~~ palsy		\| considerations_postoperative = Hypocalcemia
	~~Hypocalcemia~~		Recurrent laryngeal nerve palsy
	}}		}}
	A '''thyroidectomy''' is a procedure used to treat patients with hyperthyroidism that has not responded to conservative medical treatment. Procedure can involve the removal of the entire thyroid gland (total thyroidectomy), removal of 1 lobe (thyroid lobectomy, or hemithyroidectomy), or some variation. The procedure is usually done as an open thyroidectomy, though a minimally invasive transoral thyroidectomy can also be performed.		A '''thyroidectomy''' is a procedure used to treat patients with hyperthyroidism that has not responded to conservative medical treatment. Procedure can involve the removal of the entire thyroid gland (total thyroidectomy), removal of 1 lobe (thyroid lobectomy, or hemithyroidectomy), or some variation. The procedure is usually done as an open thyroidectomy, though a minimally invasive transoral thyroidectomy can also be performed.

Chris.Rishel at 06:41, 5 April 2022

2022-04-05T06:41:19Z

← Older revision		Revision as of 23:41, 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
			Neuromonitoring
	\| considerations_preoperative =		\| considerations_preoperative =
	\| considerations_intraoperative =		\| considerations_intraoperative =
	\| considerations_postoperative =		\| considerations_postoperative = RLN palsy
			Hypocalcemia
	}}		}}
	A '''thyroidectomy''' is a procedure used to treat patients with hyperthyroidism that has not responded to conservative medical treatment. Procedure can involve the removal of the entire thyroid gland (total thyroidectomy), removal of 1 lobe (thyroid lobectomy, or hemithyroidectomy), or some variation. The procedure is usually done as an open thyroidectomy, though a minimally invasive transoral thyroidectomy can also be performed.		A '''thyroidectomy''' is a procedure used to treat patients with hyperthyroidism that has not responded to conservative medical treatment. Procedure can involve the removal of the entire thyroid gland (total thyroidectomy), removal of 1 lobe (thyroid lobectomy, or hemithyroidectomy), or some variation. The procedure is usually done as an open thyroidectomy, though a minimally invasive transoral thyroidectomy can also be performed.

Chris.Rishel at 06:12, 22 February 2022

2022-02-22T06:12:47Z

← Older revision		Revision as of 23:12, 21 February 2022
Line 8:		Line 8:
	\| considerations_postoperative =		\| considerations_postoperative =
	}}		}}

	A '''thyroidectomy''' is a procedure used to treat patients with hyperthyroidism that has not responded to conservative medical treatment. Procedure can involve the removal of the entire thyroid gland (total thyroidectomy), removal of 1 lobe (thyroid lobectomy, or hemithyroidectomy), or some variation. The procedure is usually done as an open thyroidectomy, though a minimally invasive transoral thyroidectomy can also be performed.		A '''thyroidectomy''' is a procedure used to treat patients with hyperthyroidism that has not responded to conservative medical treatment. Procedure can involve the removal of the entire thyroid gland (total thyroidectomy), removal of 1 lobe (thyroid lobectomy, or hemithyroidectomy), or some variation. The procedure is usually done as an open thyroidectomy, though a minimally invasive transoral thyroidectomy can also be performed.

Line 18:		Line 17:
	!System		!System
	!Considerations		!Considerations
			\|-
			\|Airway
			\|
	\|-		\|-
	\|Neurologic		\|Neurologic

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

2022-02-22T05:45:38Z

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

← Older revision		Revision as of 22:45, 21 February 2022
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	\|		\|
	\|-		\|-
	\|~~Respiratory~~		\|Pulmonary
	\|		\|
	\|-		\|-

Chris.Rishel: added categories, formatting

2021-07-09T09:39:30Z

added categories, formatting

← Older revision		Revision as of 02:39, 9 July 2021
Line 9:		Line 9:
	}}		}}

	A thyroidectomy is a procedure used to treat patients with hyperthyroidism that has not responded to conservative medical treatment. Procedure can involve the removal of the entire thyroid gland (total thyroidectomy), removal of 1 lobe (thyroid lobectomy, or hemithyroidectomy), or some variation. The procedure is usually done as an open thyroidectomy, though a minimally invasive transoral thyroidectomy can also be performed.		A '''thyroidectomy''' is a procedure used to treat patients with hyperthyroidism that has not responded to conservative medical treatment. Procedure can involve the removal of the entire thyroid gland (total thyroidectomy), removal of 1 lobe (thyroid lobectomy, or hemithyroidectomy), or some variation. The procedure is usually done as an open thyroidectomy, though a minimally invasive transoral thyroidectomy can also be performed.

	== Preoperative management ==		== Preoperative management ==
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	[[Category:Surgical procedures]]		[[Category:Surgical procedures]]
			[[Category:General surgery]]
			[[Category:Endocrine surgery]]

Tony.Wang at 22:33, 5 May 2021

2021-05-05T22:33:38Z

← Older revision	Revision as of 15:33, 5 May 2021
Line 1:	Line 1:
		{{Infobox surgical case reference
		\| anesthesia_type =
		\| airway =
		\| lines_access =
		\| monitors =
		\| considerations_preoperative =
		\| considerations_intraoperative =
		\| considerations_postoperative =
		}}

		A thyroidectomy is a procedure used to treat patients with hyperthyroidism that has not responded to conservative medical treatment. Procedure can involve the removal of the entire thyroid gland (total thyroidectomy), removal of 1 lobe (thyroid lobectomy, or hemithyroidectomy), or some variation. The procedure is usually done as an open thyroidectomy, though a minimally invasive transoral thyroidectomy can also be performed.

		== 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. --> ===

		=== 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. --> ===

		=== 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. --> ===

		=== 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.
		* 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). --> ==

		{\| class="wikitable"
		\|+
		!
		!Variant 1
		!Variant 2
		\|-
		\|Unique considerations
		\|Open thyroidectomy
		\|Transoral thyroidectomy (minimally invasive)
		\|-
		\|Position
		\|
		\|
		\|-
		\|Surgical time
		\|
		\|
		\|-
		\|EBL
		\|
		\|
		\|-
		\|Postoperative disposition
		\|
		\|
		\|-
		\|Pain management
		\|
		\|
		\|-
		\|Potential complications
		\|
		\|
		\|}

		== References ==

		[[Category:Surgical procedures]]