Awake thyroidectomy under local anesthesia and dexmedetomidine infusion

Area of Science:

• Anesthesiology
• Pharmacology

Background:

• Dexmedetomidine (DEX), an alpha-2 adrenergic agonist, offers sedative and analgesic benefits.
• Patients with obstructive sleep apnea (OSA) face heightened risks of oxygen desaturation post-general anesthesia.
• Managing complex comorbidities like severe COPD and OSA necessitates careful anesthetic planning.

Observation:

• A 64-year-old male, ASA IV, with severe COPD, OSA, unilateral vocal cord dysfunction, GERD, and CHF underwent awake thyroidectomy.
• The procedure utilized local anesthesia supplemented by a dexmedetomidine infusion (1 mcg/kg loading dose, 0.2-1.0 mcg/kg/hr maintenance).
• The patient received minimal opioid (fentanyl 250 mcg) and ketorolac (7.5 mg) during the surgery.

Findings:

• The patient tolerated the awake thyroidectomy well, maintaining cooperation with commands.
• Hemodynamic stability was observed throughout the surgical procedure.
• Post-operatively, the patient reported a low pain score of 2/10 in the recovery unit.

Implications:

• Dexmedetomidine infusion is a viable option for awake thyroidectomy in high-risk patients.
• This anesthetic strategy can facilitate patient cooperation and potentially reduce opioid requirements.
• Careful patient selection and monitoring are crucial for successful outcomes in complex cases.