Postoperatively, she develop acute respiratory distress and agitation whilst in the recovery room. She has developed neck swelling and you suspect a haematoma has developed. Give 4 other causes for agitation and respiratory distress in a patient in the immediate postoperative period following thyroid surgery?

Cause
Mechanisms
Neck hematoma & Bleeding
  • Failure of haemostasis
  • Haematoma can causing airway compression
Laryngeal Oedema (1)
  • Traumatic intubation
  • Complex surgery
  • Reduced venous drainage
Recurrent Laryngeal Nerve Palsy (1)
  • Can be cause by traction, ischaemia, entrapment or transection
  • May be unilateral or bilateral both of which may lead to stridor
Tracheomalacia (Rare) (1)
  • Sustained compression from large goitre
  • Pressure atrophy and erosion of the cartilaginous tracheal rings results in post-operative A-P collapse of the trachea
Laryngeal Tetany due to Hypocalcaemia (Rare)
  • Unintended trauma or removal of parathyroid glands
  • Severe hypocalcemia can induce tetany and laryngospasm
  • Permanent hypocalcemia is rare but transient hypocalcemia seen in up to 20% of patients
  • Generally presents at 24-48 hours postoperatively
Pneumothorax (Rare) (1)
  • Retrosternal dissection of large goitre