Cushings reflex secondary to neck hematoma following thyroidectomy
Abinaya Anand and Devraj
Kasturba Medical College, India
: J Otol Rhinol
Abstract
Introduction: The incidence of neck hematoma following thyroidectomy range from 1.36% to 2.57%. We identified certain unique features in our case which suggested an alternative cause for respiratory distress, not suggested in the literature. Case Report: A 63-year old female patient was referred by the endocrinologist to the Department of Otorhinolaryngology and Head and Neck Surgery for the surgical management of toxic nodular goiter. She was euthyroid and was also on active treatment for hypertension and diabetes mellitus. The surgical procedure went uneventful and just before extubation bilateral vocal cord mobility was confirmed. At around 4th hour after surgery blood pressure shot up to 190/130 mmHg and heart rate was between 35 and 40. She became restless rapidly, her breathing pattern changed, she developed uprolling of eyeballs and had a near cardiac arrest. She was immediately re-intubated by the anesthetist and the surgical resident evacuated a hematoma of 150- 200 ml from the surgical bed at the same time. Anterior jugular vein was identified as the bleeder vessel and ligated. She required inotrope support for a few hours and was extubated successfully after 24 hours of monitoring. Discussion & Conclusion: Causes suggested for respiratory distress following hematoma post thyroidectomy include tracheal compression and supraglottic lymphovenous edema. The rapidity with which she deteriorated the ease of reintubation and also the amount of hematoma collection found on re-exporation could not be explained by these. Hence we propose Cushing syndrome as the cause of respiratory distress in our case and propose the need for surgeons to be vigilant about this rare surgical emergency.
Biography
Abinaya Anand has completed her Bachelors from Tirunelveli Medical College, Tamil Nadu and is pursuing her Postgraduate studies in Otolaryngology in Kasturba Medical College, Manipal University, Karnataka, India. She is interested in original research work, new concepts in the emerging medical field, endoscopic and microscopic surgeries and quality patient care.
E-mail: abinayashrivignesh@gmail.com
