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Local Anesthesia With Monitored Anesthesia Care vs General Anesthesia in Thyroidectomy: A Randomized Study.
Samuel K Snyder1, Charles R Roberson, Carol C Cummings
1Department of Surgery, Texas A&M University System Health Science Center College of Medicine, Scott & White Clinic and Foundation, Temple, Tex 76508, USA. ssnyder@swmail.sw.org
Archives of Surgery (Chicago, Ill. : 1960)
|February 24, 2006
Summary
Thyroid surgery can be safely performed using local anesthesia with monitored anesthesia care (MAC), yielding results comparable to general anesthesia. This approach facilitates same-day discharge, potentially reducing healthcare costs.
Area of Science:
- Surgical Anesthesiology
- Endocrine Surgery
- Outpatient Surgery
Background:
- Historically, thyroid surgery utilized local anesthesia before the widespread adoption of general anesthesia.
- Recent studies suggest comparable outcomes for thyroidectomy under local anesthesia versus general anesthesia.
- Local anesthesia may enable same-day discharge, reducing hospital stay duration.
Purpose of the Study:
- To compare the efficacy and safety of thyroidectomy performed under local anesthesia with monitored anesthesia care (MAC) versus general anesthesia.
- To evaluate the feasibility of outpatient thyroidectomy using local anesthesia with MAC.
- To assess the impact of anesthetic technique on postoperative recovery and patient satisfaction.
Main Methods:
- A prospective randomized study involving adult patients undergoing thyroidectomy.
- Comparison of local anesthesia with MAC group (n=29) versus general anesthesia group (n=29).
- Evaluation of outcomes including complications, hospital admission, postoperative time, and patient satisfaction. Pre- and post-study comparison of anesthetic techniques and discharge settings.
Main Results:
- No significant differences in demographics, complications, or patient satisfaction between the two anesthetic groups.
- 88% of all procedures were completed as outpatient surgeries.
- Patients under local anesthesia with MAC had shorter postoperative stays in the outpatient setting compared to general anesthesia (P = .02).
- Significant increase in the utilization of local anesthesia with MAC and outpatient thyroidectomies post-study (P<.001).
Conclusions:
- Thyroidectomy under local anesthesia with MAC offers similar operative and clinical results, along with comparable patient satisfaction, to general anesthesia.
- Local anesthesia with MAC can decrease postoperative recovery time in outpatient settings, potentially leading to healthcare cost savings.
- Outpatient thyroidectomy is a viable option for selected patients, enhanced by local anesthesia techniques.