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Minimally invasive parathyroidectomy using cervical block: reasons for conversion to general anesthesia
Tobias Carling1, Patricia Donovan, Christine Rinder
1Yale University School of Medicine, New Haven, CT 06510, USA.
Archives of Surgery (Chicago, Ill. : 1960)
|April 19, 2006
Summary
Minimally invasive parathyroidectomy is often successful with cervical block anesthesia. Conversion to general anesthesia (GA) was needed in 10.6% of cases for reasons like unexpected findings or patient comfort.
Area of Science:
- Endocrinology
- Anesthesiology
- Surgical Oncology
Background:
- Primary hyperparathyroidism is a common endocrine disorder.
- Minimally invasive parathyroidectomy offers advantages over traditional surgery.
- Cervical block anesthesia is an alternative to general anesthesia for this procedure.
Purpose of the Study:
- To determine the frequency of conversion from cervical block anesthesia to general anesthesia (GA) during minimally invasive parathyroidectomy.
- To identify the reasons for such conversions.
Main Methods:
- Prospective case series of 441 patients undergoing minimally invasive parathyroidectomy.
- Cervical block anesthesia with monitored anesthesia care was the primary anesthetic technique.
- Conversion to general endotracheal anesthesia was the main outcome measure.
Main Results:
- 10.6% (47/441) of patients required conversion to GA.
- Reasons included simultaneous thyroid resection (16), persistent hyperparathyroidism requiring extensive exploration (15), recurrent laryngeal nerve protection (8), patient comfort (5), and unexpected parathyroid carcinoma (2).
- One patient had a lidocaine reaction causing a seizure.
Conclusions:
- Cervical block anesthesia is suitable for most minimally invasive parathyroidectomies.
- Conversion to GA is justified for unexpected intraoperative findings or to ensure patient comfort.
- Careful patient selection and anesthetic planning are crucial.
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