Hematoma with Airway Compromise after Thyroidectomy

Shortly after the patient’s trachea was extubated after a thyroidectomy, a rare but serious complication occurred. A rapidly expanding hematoma formed, leading to airway compromise and inadequate ventilation (fig. 1). Immediate action, including reintubation and evacuation of the hematoma, was required to address the situation (fig.2; Supplemental Video, https://links.lww.com/ALN/D258).

The reported hematoma formation after thyroidectomy ranges broadly from 0.5 to 7% of cases.  Risk factors include increasing age and male sex.  While hematoma formation is known to occur, instances leading to airway obstruction are exceedingly rare. 

In such critical situations, prompt diagnosis and intervention are essential to prevent further deterioration and ensure adequate oxygenation. Immediate measures including reintubation may be necessary, and the anesthesia and surgical teams must carefully coordinate their response.

Managing airway emergencies after thyroidectomy requires a multidisciplinary approach including strategic extubation planning, maintaining surgical field sterility, and ensuring the presence of the anesthesiologist, surgeon, and experienced nurses to promptly handle any complications.

Surgeons take precautions to minimize the risk of bleeding after thyroidectomy; use of vessel-sealing devices, topical hemostatic agents, and rigorous attention to hemostasis pre-closure are all standard in this institution. Anesthesiologists can assist by employing techniques such as the Valsalva maneuver or positioning the patient in a 30-degree Trendelenburg position to increase venous pressure and identify potential bleeding points. During emergence from anesthesia, careful monitoring and blood pressure control, along with a smooth extubation process and prevention of nausea and vomiting, are important. 

In the rare event that a hematoma does occur, prompt recognition and collaborative management are critical to patient safety.