Trans oral thyroidectomy, Trans Axillary thyroidectomy are done for cosmetic reasons especially in young adults. Anaesthesitic considerations , in addition to routine measures: Preoperative evaluation should include Carotid doppler, Cardiac evaluation, Vascular assessment, Cerebral perfusion assessment. History of convulsions, should be taken . Carbon dioxide Co2 pressure should be kept below central venous pressure preferably below 5-8 mmHg. This is to allow Jugular venous flow and prevent cerebral edema . Etco2 , Mean arterial pressure, ABG should be periodically checked .
Intra-operatively pupillary size should be monitored . Intra operative fundoscopy is also suggested in prolonged surgeries. Nasal Intubation with prior Lidocaine jelly and Xylometazoline nasal drops as usual . Good muscle relaxation + hypotensive anaesthesia + Pro coagulants etc are mandatory. Atenolol…
