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04-05-2006 | Thyroid | Article

General anesthesia 'unnecessary' for many HPT surgeries


Free abstract

Scientists advise that most minimally invasive parathyroidectomies (MIPs) for patients with primary parathyroidism (HPT) can be performed using cervical block anesthesia without the need for general anesthesia (GA).

Lead author Robert Udelsman, from Yale University School of Medicine in New Haven, Connecticut, USA, and co-workers comment in the Archives of Surgery that the use of MIP has improved outcomes for patients with HPT.

Moreover, while the MIP procedure is "generally performed with the patient awake, using surgeon-administered cervical block and monitored anesthesia care," they note, "in some instances, conversion to GA is performed."

For their study, the team evaluated the frequency and reasons for conversion to general endotracheal anesthesia in 441 patients with HPT who underwent MIP with cervical block anesthesia.

Overall, 47 (10.6%) of the patients required conversion to GA. Sixteen of these individuals required conversion to carry out simultaneous thyroid resection.

In another 15 of the patients, conversion to GA was necessitated due to "extensive exploration" required when intraoperative parathyroid hormone levels failed to decrease by at least 50% from baseline after resection of the parathyroid tumor.

Technical difficulties associated with ensuring adequate protection of the recurrent laryngeal nerve explained conversion to GA in another eight individuals, and GA was administered to five individuals to improve levels of comfort.

In the remainder, conversion to GA was carried out because of a toxic reaction to lidocaine in one patient and intraoperative recognition of parathyroid carcinoma in two individuals.

Summarizing, Udelsman et al say: "The most common reason [for conversion to GA] was unrecognized concomitant thyroid pathologic features. This rate corresponds to those previously reported in the literature."

They conclude: "The vast majority of MIPs can be performed using cervical block anesthesia. However, conversion to GA is appropriate when unexpected intraoperative findings are encountered for patient comfort."