General Preoperative Workup, Informed Consent, Antibiotic Prophylaxis, and Anesthesia in Thyroid Surgery

Thyroidectomy is the treatment of choice for benign and malignant thyroid disease. The diagnostic workup has to define the thyroid disease, the therapeutic strategy, and the extension of the potential surgery. Providing patient education is a fundamental step in the surgeon-patient relationship and it is performed before any medical-surgical intervention with the aim of enabling the patient’s conscious self-determination. Patients should be adequately informed by the surgeon about the indications for surgery, alternative treatments, complications and possible permanent consequences. Thyroid surgery is considered a clean procedure, and hence antibiotic prophylaxis should not be routinely employed except under specific conditions. Anesthesia for thyroid surgery requires an experienced team in the recognition, assessment, and management of a potentially difficult airway, in a patient who may also have significant comorbidity. Neuromonitoring is effective for identifying and monitoring the function of the laryngeal nerves. The anesthetist is actively involved in this procedure, in particular as concerns correct positioning of the endotracheal tube and management of the neuromuscular blockade.