Hyperparathyroidism, hypercalcemia and difficult laryngoscopy: a retrospective review

Area of Science:

• Anesthesiology
• Endocrinology
• Surgical Patient Management

Background:

• Difficult intubation rates vary, with endocrine disorders like diabetes and hyperthyroidism linked to increased incidence.
• Hypercalcemia can cause neck pain and reduced cervical range of motion, potentially impacting intubation.
• It was hypothesized that hyperparathyroidism and hypercalcemia would increase laryngoscopy intubation difficulty.

Purpose of the Study:

• To investigate the incidence of difficult laryngoscopy in patients undergoing parathyroidectomy.
• To determine if hypercalcemia is associated with increased intubation difficulty.
• To compare intubation difficulty in parathyroidectomy patients versus general abdominal surgery patients.

Main Methods:

• Retrospective chart review of 382 parathyroidectomy patients and 262 abdominal surgery patients.
• Defined difficult laryngoscopy by number of attempts and use of adjuncts or alternative devices.
• Utilized propensity score matching and logistic regression to analyze intubation difficulty and hypercalcemia.

Main Results:

• No significant difference in difficult or awkward laryngoscopy rates between parathyroidectomy and abdominal surgery patients.
• The rate of abandoning laryngoscopy for alternative intubation methods was similar between groups.
• Hypercalcemia did not demonstrate an impact on laryngoscopy difficulty.

Conclusions:

• Patients undergoing parathyroidectomy are not at increased risk for laryngoscopy intubation problems.
• Hypercalcemia does not appear to increase the risk of laryngoscopy difficulty.
• This is the first study to evaluate the impact of parathyroidectomy and hypercalcemia on intubation ease via laryngoscopy.