Gardner W. Smith

Substernal Goiter versus Intrathoracic Aberrant Thyroid: A Critical Difference

A substernal goiter may descend into the thorax. However, a truly aberrant intrathoracic thyroid represents a rare and anatomically different entity that requires appropriate modifications in approach and surgical technique.

Intraoperative Fluid Management

The surgeon should be cognizant of both the intraoperative and postoperative consequences of intraoperative fluid administration. Optimal fluid management should take into consideration the patients overall condition and should not be based solely on the cardiovascular response to volume loading. The selection of a particular fluid for resuscitation solution should be tailored to the patients individual situation. No single fluid preparation will be appropriate for all clinical situations. Crystalloids, colloids, and hypertonic saline solutions have all been shown to be effective in restoring intravascular volume. Each has its own relative advantages and disadvantages and will be appropriate in differing situations. Colloid preparations should not be avoided for fear of inducing pulmonary edema, and the use of hypertonic solutions should not be precluded by fear of potential metabolic complications. The judicious use of both hypertonic solutions and colloids is safe. For the vast majority of routine surgical cases, where the patient is hemodynamically stable and postoperative fluid overloading is not a significant problem, isotonic crystalloids such as lactated Ringers are both sufficient and cost effective.