Parathyroidectomy Flashcards
What are the most common preoperative diagnoses
for someone undergoing parathyroidectomy?
Parathyroid adenoma, hyperplasia, hyperparathyroidism, and
parathyroid carcinoma
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 679.
What is the usual preoperative volume status of a
patient presenting for parathyroidectomy for
hyperparathyroidism?
They are often hypovolemic due to polyuria.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 681.
What electrolyte disorder(s) would you expect to see
in a patient with symptomatic hyperparathyroidism
presenting for parathyroidectomy?
Hypercalcemia (and as a result, hypophosphatemia)
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 681.
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.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 680.
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.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 681.
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.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 681.
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.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 681.
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.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 679.
What amount of blood loss would you expect to be
typical for a parathyroidectomy?
Minimal (25-50mL)
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 680.
Where is the incision made for a traditional
parathyroidectomy?
It’s a transverse cervical incision about 4-8 cm long.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 679.
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.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 680.
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.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 682.
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.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 682.
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.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 682.
