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CASE REPORT
Cushing’s reflex secondary to neck haematoma following thyroidectomy
  1. K Devaraja1,
  2. Dipak Ranjan Nayak1,
  3. Abhishek Rao Kordcal2,
  4. Sumeet Suresh Malapure3
  1. 1Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
  2. 2Anasethesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
  3. 3Nuclear Medicine Division, Radiotherapy, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
  1. Correspondence to Dr K Devaraja, deardrdr{at}gmail.com

Summary

Neck haematoma following thyroid surgery can present with respiratory distress which is generally attributed to airway obstruction. We recently had a 63-year-old female patient who underwent total thyroidectomy for toxic nodular goitre. However, within 4 hours of surgery, she developed sudden respiratory distress which was managed by prompt evacuation of the neck haematoma. Just before the haematoma evacuation, the patient had hypertension and bradycardia along with the distress. The arterial blood gas analysis sampled at that time was normal. Intraoperatively, the tracheal framework was found rigid and non-pliable. Considering the various clinical–biochemical findings observed, we think that the cause of the respiratory distress in the index case was transiently elevated intracranial pressure, secondary to bilateral internal jugular veins' compression. We hypothesise that in many patients with immediate postoperative neck haematoma, the Cushing’s reflex would at least contribute partly, if not solely to the respiratory distress.

  • anaesthesia
  • cardiovascular medicine
  • ear, nose and throat/otolaryngology
  • resuscitation
  • thyroid disease
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Footnotes

  • Contributors KD was involved in clinical care, literature review, data collection, analysis, manuscript preparation, editing and submission. DRN was involved in clinical care, literature review, data analysis, manuscript editing and submission. ARK was involved in clinical care, data collection, analysis, manuscript preparation and editing. SSM was involved in clinical care, data analysis, manuscript preparation, editing and submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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