THYROID-SURGERY USING MONITORED ANESTHESIA CARE - AN ALTERNATIVE TO GENERAL-ANESTHESIA

Forty consecutive patients undergoing thyroid surgery under local anes thesia (LA) by a single surgeon over a 5-year period were included in this retrospective review. In all cases, the indication for LA was pat ient request. The study included 29 females and 11 males with an avera ge age of 44 years (range 22-66 years). Body habitus was thin in 12.5% , average in 67.5%, and obese in 20%. Operations consisted of 21 unila teral thyroid lobectomies, 3 partial thyroidectomies, 3 subtotal thyro idectomies, and 13 total thyroidectomies. The pathology revealed benig n disease in 45% and malignant disease in 55%. An procedures were perf ormed using lidocaine and/or bupivacaine to administer a deep cervical plexus block as well as a field block. Mild additional intraoperative intravenous sedation was provided in most cases. Two patients were co nverted emergently to general endotracheal anesthesia because of inabi lity to tolerate LA in one and a seizure secondary to intraarterial in jection of lidocaine in the other patient There were no instances of w ound infection hemorrhage, recurrent laryngeal nerve injury, or hypopa rathyroidism. In conclusion, thyroid surgery in selected patients can be performed safely using LA by experienced surgeons. If patients are carefully prepared preoperatively, LA offers a simple and reasonable a lternative to general anesthesia.