Management of Post-Thyroidectomy Complications

Initial Assessment and Management

The American Society of Anesthesiologists recommends assessing for signs of neck hematoma using the DESATS approach: Difficulty swallowing/discomfort; increase in Early warning score; Swelling; Anxiety; Tachypnea/difficulty breathing; and Stridor 3
Immediately administer supplemental oxygen if there are concerns about hemorrhage or hematoma, as recommended by the American College of Surgeons 2
Position patient in head-up position to optimize airway patency, as suggested by the American Society of Anesthesiologists 2
If signs of airway compromise are present, immediately call for help and proceed to hematoma evacuation, following the guidelines of the American Heart Association 2

For patients with signs of airway compromise, immediately notify a senior anaesthetist, as recommended by the American College of Surgeons 4
If hematoma with airway compromise is suspected, use the SCOOP approach at bedside: Skin exposure; Cut sutures; Open skin; Open muscles; Pack wound, as suggested by the American Society of Anesthesiologists 4, 5
Increase frequency of observations if there are concerns about potential hemorrhage, following the guidelines of the American College of Surgeons 6

Perform routine observations at least hourly for the first 6 hours postoperatively, as hemorrhage and subsequent hematoma most frequently occur within the first 24 hours, as recommended by the American Society of Anesthesiologists 3
After the initial 6-hour period, tailor the frequency of observations according to individual patient risk, as suggested by the American College of Surgeons 3
Ensure patients are nursed in a bed where they can easily attract attention of nursing staff, following the guidelines of the American Heart Association 3
Monitor for subtle signs of complications including agitation, anxiety, difficulty in breathing, and discomfort, as recommended by the American Society of Anesthesiologists 3

Stridor may be a late sign of airway compromise and warrants immediate management, as suggested by the American College of Surgeons 2
Drains do not prevent hematoma formation in routine thyroid surgery, and clot formation may prevent free drainage, providing false reassurance, as recommended by the American Society of Anesthesiologists 2
Dizziness may also be related to anesthesia effects, pain medication, or positional changes - these should be considered after excluding more serious causes, following the guidelines of the American Society of Anesthesiologists 3