Monitoring
- Standard AAGBI monitoring
- Continuous temperature monitoring:
- Risk of hyperthermia or hypothermia in patients with thyroid disease
- Recurrent laryngeal nerve neuromonitoring:
- Specialist NIM tube required
- May reduce incidence of RLN palsy
Positioning
- Supine with head fully extended:
- Padded ring under head
- Padded roll under shoulders
- Slight head up favourable to promote venous drainage
- Vigilance needs to be taken to pad and cover eyes if thyroid eye disease
Conduct
- Following intubation neuromuscular blockade is avoided if RLN neuromonitoring is being performed
- High risk of nausea and vomiting – ensure anti-emetics given
- Dexamethasone useful in reducing postoperative airway oedema
- Prior to closing checks for haemostasis may be requested:
-
- ‘Passive’ valsalva maneuver
- Period of normotension / hypertension