Anaesthesia for thyroid and parathyroid surgery

In the UK, Stanley Rowbotham pioneered anaesthesia for thyroid surgery in the 1940s. He combined local anaesthesia with light general anaesthesia, and even attempted to make the patient strain to test haemostatic sutures using one breath of ether. Anaesthesia for thyroid surgery requires an anaesthetist who is experienced in the recognition, assessment, and management of a potentially difficult, shared airway, in a patient who may also have significant co-morbidity. Complexity of the procedure may vary from excision of a simple nodule to removal of retrosternal goitre to relieve tracheal compression. The latter can be excised through a standard collar incision, but it may be necessary to split the sternum to access the inferior pole of the enlarged gland. Although blood loss is usually minimal, there is potential for major haemorrhage from large blood vessels closely related to the gland, particularly if the thyroid extends retrosternally.