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There are several specific issues that significantly affect the anesthetic management for patients undergoing thyroid surgery. In addition to the general considerations pertaining to anesthesia, specific attention should be directed to the assessment of thyroid function, the size and location of the thyroid gland, its relationship to the trachea and adjacent vascular structures, and the co-existence of a multiple endocrine neoplasia. Hyperparathyroidism due to an adenoma or hyperplasia is the most common presenting symptom of multiple endocrine neoplasia 1 syndrome. Patients at risk of iatrogenic hypoparathyroidism should have ionized calcium levels monitored postoperatively until calcium levels demonstrate that parathyroid function is intact. Primary hyperparathyroidism may result from benign parathyroid adenoma, multiple gland hyperplasia and carcinoma of the parathyroid glands. Clinical signs include carpopedal spasm during cuff inflation, facial twitching by tapping over the facial nerve at the parotid gland, and a prolonged QT interval on the ECG.
This chapter introduces some of the more common otolaryngology instruments used during procedures involving the larynx, trachea, cervical esophagus, pharynx, and paranasal sinuses. Surgery of the larynx, pharynx, and trachea begins with securing the airway with an appropriate device that will allow for adequate ventilation. Many cases of septoplasty and rhinoplasty are performed under local anesthesia with varying degrees of sedation. Transoral robotic surgery is an emerging technology that is becoming more common at tertiary care centers. Surgery of the upper aerodigestive tract deals with diverse pathology that requires a variety of special surgical instrumentation. Given the demands of the surgeon and anesthesiologist, it is crucial for optimal patient care that open communication before, during, and after the procedure be the standard operating protocol. Basic understanding of otolaryngologic instrumentation as described in the chapter will hopefully allow for mutual understanding between the surgical and anesthesia teams.