Case Report: Minimally Invasive Thyroidectomy for a 35-Year-Old Female with BMI 30

The patient, a 35-year-old female with a BMI of 30, presented with thyroid-related concerns necessitating Minimally Invasive Thyroidectomy. Given the patient’s age and BMI, meticulous anaesthesia management was crucial to ensure optimal surgical conditions and patient safety.

To ensure comprehensive monitoring during the procedure, the following measures were implemented:

  • Standard monitoring, including ECG, NIBP, pulse oximetry, and capnography.
  • Continuous end-tidal carbon dioxide (ETCO2) levels are monitored to assess ventilation adequacy.
  • Intravenous access was secured for fluid and medication administration.

Patient Positioning and Preoperative Preparation:

  • Supine position with the neck extended and the chin in the midline.
  • General anaesthesia was administered with endotracheal intubation.

Trocar Insertion and Pneumoinsufflation:

  • Appropriate trocars placed.
  • Pneumoinsufflation was initiated to maintain 6 to 8 mmHg pressure.
  • Close monitoring of ventilation and ETCO2 levels.

Effect of Pneumoinsufflation on Patient:

  • Aids in opening the subplatysmal plane and maintains an adequate operative space.
  • Decreases the impact of minor bleeds.
  • Continuous monitoring of potential effects on ventilation and ETCO2 levels.

Additional Considerations:

  • Tranexamic acid mitigates intraoperative bleeding, contributing to better surgical field visibility.

Intraoperative Bleeding and ETCO2:

  • Close monitoring of ETCO2 to promptly identify changes in ventilation.
  • Managing bleeding is crucial to prevent increases in ETCO2 levels and minimize respiratory complications.

End of Procedure and Ensuring Hemostasis for Improved Visibility:
a. Perform a Valsalva Maneuver to assess potential bleeding and ensure hemostasis.
b. Maintain controlled hypotension to enhance surgical field visibility.
c. Flex the neck to inspect for any additional bleeding sites.

Extubation Without Bucking for Postoperative Considerations:

  • Extubation is done without bucking to minimize stress on the surgical site and prevent potential complications during the postoperative phase.

Minimally Invasive Thyroidectomy, in this case, involved meticulous anaesthesia management, taking into account the patient’s age, BMI, and the specific considerations of the procedure. Continuous monitoring of ETCO2, controlled hypotension, and strategic use of tranexamic acid contributed to successful surgical outcomes and patient safety. The adoption of specific techniques, such as the Valsalva manoeuvre, neck flexion at the end of the procedure, and extubation without bucking, played essential roles in ensuring hemostasis, optimal surgical conditions, and postoperative well-being. The focus on better surgical field visibility underscored these measures’ importance in enhancing the surgical procedure’s overall quality.


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