What are the postoperative concerns?
The postoperative concerns after thyroid surgery are as follows:
· The possibility of thyroid storm occurring is still present.
· Injury to the recurrent laryngeal nerve during surgery causes vocal cord paralysis, and occurs transiently in 3–4% of thyroidectomies. Unilateral injury causes inef-fective cough, hoarseness, and risk of aspiration. Bilateral injury causes airway obstruction. Injury to the nerve may be due to traction or transection, and should be suspected if the surgeon had difficulty identifying the nerves.
· Postoperative bleeding may result in rapidly expanding hematomas that can quickly obstruct the airway. Postanesthesia care unit (PACU) and ward staff should monitor the patient for airway compromise. Opening the wound will usually temporarily relieve the airway obstruction. Ultimately, the patient’s trachea should be reintubated and the patient returned to the operating room for evacuation of the hematoma and control of the bleeding. Edema from venous congestion may result in continued airway obstruction.
· Large, long-standing goiters can cause tracheomalacia leading to postoperative airway obstruction. This com-plication more commonly occurs with retrosternal goiters. In cases of suspected tracheomalacia, the patient should demonstrate the ability to breathe around the endotracheal tube with the balloon deflated prior to extubation. Airway obstruction from tracheomalacia may require reintubation, tracheostomy, or stenting of the airway.
· Postoperative hypocalcemia from parathyroid injury or inadvertent resection is common, and usually transient. Hypocalcemia may present in the PACU as airway obstruction. Calcium levels should be checked starting 2 hours postoperatively, with replacement as necessary.
· There is an increased incidence of nausea and vomiting. There are multiple ways of reducing this risk, including use of propofol for the anesthetic, avoidance of nitrous oxide, and treatment with antiemetics.