Complete Airway Obstruction and Massive Hemorrhage from Post-Thyroidectomy Neck Hematoma: A Case Report and Management Algorithm

Abstract

Postoperative Neck Hematoma (PONH) is a potentially life-threatening complication of neck/thyroid procedures due to massive hemorrhage and/or acute airway compromise (often associated with difficult airway management) requiring immediate surgical re-intervention. Patient survival often relies on optimal crisis resource management skills of the care team. We describe the case of a PONH in an elderly patient in the immediate post-thyroidectomy period, presenting with acute respiratory failure/arrest and massive hemorrhage with hemodynamic instability. We outline the approach taken to successfully manage this emergency and highlight critical management steps including the leadership role of the anesthesiologist that ultimately resulted in a positive outcome.