Challenges of Thyroidectomy Anaesthesia for a Huge Retrosternal Goitre in a Jehovah’s Witness: A Case Report

Abstract

In potential haemorrhagic surgical procedures, refusal of allogenic blood infusion poses a challenge to anaesthetists. This report is about a 65-year-old male, of the Jehovah’s Witness (JW) religious sect, known hypertensive, who presented with an anterior neck mass with retrosternal extension of three years. Laboratory investigations were normal, and the haemoglobin concentration was 13gm/dl. He consented to acute normovolaemic haemodilution (ANH). Therefore, two units of blood were drawn and replaced with isoplasma. The patient had a general anaesthesia relaxant technique. Intravenous tranexamic acid, morphine, and paracetamol were administered. A right-lobal thyroidectomy and sternotomy were performed. After securing haemostasis, the two blood units were infused, and the estimated blood loss was 1.5 litres. The surgery lasted for five and a half hours. After surgery, the patient was reversed of the neuromuscular blockade, extubated, transferred to the intensive care unit (ICU), and monitored for 24 hours. He had supplemental oxygenation, analgesia, and other supportive care. He was discharged on postoperative day seven and had attended the outpatient clinic for two months.