Parathyroidectomy Flashcards
What are the most common preoperative diagnoses
for someone undergoing parathyroidectomy?
Parathyroid adenoma, hyperparathyroidism, and parathyroid carcinoma
What is the usual preoperative volume status of a
patient presenting for parathyroidectomy for
hyperparathyroidism?
They are often hypovolemic due to polyuria.
What electrolyte disorder(s) would you expect to see in a patient with symptomatic hyperparathyroidism presenting for parathyroidectomy?
Hypercalcemia (and as a result, hypophosphatemia)
A patient with symptomatic hyperparathyroidism is
presenting for a parathyroidectomy. What are the
respiratory implications of this?
Hyperparathyroidism results in a decreased ability to clear secretions from the respiratory tract and the patient may be prone to atelectasis.
You are performing a preoperative evaluation on a
patient scheduled for a parathyroidectomy for
hyperparathyroidism. The patient asks if he should
take his pamidronate the morning of surgery. What
should you answer?
Pamidronate and zolendronic acid are used to treat
hypercalcemia and are commonly administered to patients with hyperparathyroidism. These medications should be continued up until the time of surgery.
A patient presenting for parathyroidectomy for
hyperparathyroidism has hypophosphatemia. How
would this affect coagulation? Ventricular function?
Leukocyte function?
Hypophosphatemia impairs coagulation by causing platelet dysfunction. It also impairs ventricular contractility and
leukocyte function.
Should you administer routine premedications to a
patient undergoing a parathyroidectomy for
hyperparathyroidism?
Yes, unless the patient exhibits altered mental status due to electrolyte imbalances
You are about to take a patient to surgery for a
parathyroidectomy. In the preop holding area, you
see that the patient is receiving methylene blue
intravenously. Why is this?
Methylene blue (7.5 mg/kg in 500 mL of NS) may be administered to aid in the identification of parathyroid tissue. Radioactive technetium sestamibi may also be used, either independently or together with methylene blue to help identify parathyroid tissue
What amount of blood loss would you expect to be
typical for a parathyroidectomy?
Minimal (25-50mL)
Where is the incision made for a traditional
parathyroidectomy?
It’s a transverse cervical incision about 4-8 cm long.
During a parathyroidectomy, the surgeon asks if you can perform a deep extubation on the patient? What do you surmise is his concern?
Coughing can lead to venous congestion, bleeding, and the formation of potentially life-threatening hematomas in the neck on emergence.
What electrolyte abnormality is most common
following parathyroidectomy? When does it occur?
Hypocalcemia. It can occur in the immediate postoperative period, but the lowest calcium level seen is usually 4-5 days after surgery
Following a parathyroidectomy, a patient in the
recovery room begins having a seizure. What
treatment options should you consider?
After securing an airway and stable hemodynamic status, you may consider administering 10-20 mL of calcium gluconate 10% over 10 minutes. Laryngospasm, tetany, and seizures may
occur due to sudden hypocalcemia in patients following a parathyroidectomy.
Following a parathyroidectomy, an awake and alert
patient is unable to unable to phonate and exhibits
difficulty breathing. What do you suspect?
The inability to phonate indicates possible bilateral recurrent laryngeal nerve damage. Unilateral damage typically presents as persistent hoarseness.
