Maya BELİTOVA, Rumen PANDEV, Dimitar KARADIMOV

General or local anaesthesia in one-day thyroid surgery-Does it matter?

Amaç: Günübirlik Tiroid Cerrahisinde (GTC) lokal anestezi + Monitörize Anestezi Bakımına (LA+MAB) kıyasla genel anestezinin (GA) güvenliliği ve uygulanabilirliğini belirlemeyi ve anestetik yaklaşımların herbirine karşı hasta ve operatör memnuniyetini değerlendirmeyi hedefledik. Materyal ve Metotlar: 2008’den 2011’e kadar GTC uygulanan 130 hastayı prospektif olarak inceledik. 64 hasta GA altında ve 62 hasta LA+MAB altında opere edildi. Hastaların demografik özellikleri ile ilgili tüm değişkenler, operasyon tipi ve süresi , postoperatif komplikasyonlar, havayolu yönetimindeki zorluk ve postoperatif opiat tüketimi kayıt ve analiz edildi. Bulgular: İki grup arasında hastanede yatış süresi, taburculuk süresi ve majör/minör komplikasyon oranı açısından fark yoktur ancak LA+MAB grubunda (56 dk; VAS 6, 5), GA grubuna göre (223 dk; VAS 1, 5) ağrı daha erken ortaya çıkmaktadır ve daha şiddetlidir (p

Günübirlik tiroid cerrahisinde genel veya lokal anestezi – Fark eder mi?

Objective: We aimed to determine the safety and feasibility of general anaesthesia (GA) compared with local anaesthesia + Monitored Anaesthesia Care (LA+MAC) for One-Day Thyroid Surgery (ODTS); to assess patient and operator satisfaction with either of the anesthetic approaches. Material and Methods: We reviewed prospectively 130 patients who underwent ODTS from 2008 to 2011. 64 patients were operated on under GA and 62 - under LA+MAC. All variables of patient demographic characteristics, duration and type of operation, postoperative complications, difficulty in airway management and postoperative opiate consumption were recorded and analyzed. Results: There is no difference in respect to length of stay, discharge time and major/minor complications rate between two groups, but in the LA+MAC group, pain appears earlier and is more severe (56min; VAS 6, 5) than in GA patients (223 min; VAS 1, 5; p

PDF

___

1. Spanknebel K, Chabot JA, DiGiorgi M, Cheung K, Lee S, Allendorf J, et al. Thyroidectomy Using Local Anaesthesia: A Report of 1,025 Cases over 16 Years. J Am Coll Surg 2005;201:375-85. [CrossRef]
2. Sahai A, Symes A, Jeddy T. Short-stay thyroid surgery. Br J of Surg 2005;92:58-9. [CrossRef]
3. Ortega J, Cassinello N, Lledy S. ‘Same-day’ thyroid surgery. Results after 805 thyroidectomies in a fast-track. Cirurgía Esp 2007;82:112-6. [CrossRef]
4. Segerdahl M, Warren-Stomberg M, Rawal N, Brattwall M, Jakobsson J. Clinical practice and routines for day surgery in Sweden: results from a nation-wide survey. Acta Anaesthesiol Scand 2008;52:117-24. [CrossRef]
5. Teoh AY, Tang YC, Leong HT. Feasibility study of day case thyroidectomy. ANZ J Surg 2008;78:864-6. [CrossRef]
6. Mirnezami R, Sahai A, Symes A, Jeddy T. Day-case and shortstay surgery: the future for thyroidectomy? Int J Clin Practice 2007;61;1216-22. [CrossRef]
7. Chin CW, Loh KS, Tan KS. Ambulatory thyroid surgery: an audit of safety and outcomes. Singapore Med J 2007;48:720-4.
8. Materazzi G, Dionigi G, Berti P, Rago R, Frustaci G, Docimo G, et al. One-Day Thyroid Surgery: Retrospective Analysis of Safety and Patient Satisfaction on a Consecutive Series of 1,571 Cases over a Three-Year Period. Eur Surg Research 2007;39:182-8. [CrossRef]
9. Chapuis Y, Icard P, Fulla Y, Nonnenmacher L, Bonnichon P, Louvel A, et al. Parathyroid adenomectomy under local anaesthesia with intra-operative monitoring of UcAMP and/or 1-84 PTH. World J Surg 1992;16:570-5. [CrossRef]
10. Ditkoff BA, Chabot J, Feind C, Lo Gerfo P. Parathyroid surgery using monitored anaesthesia care as an alternative to general anaesthesia. Am J Surg 1996;172:698-700.
11. Chen H, Sokoll LJ, Udelsman R. Outpatient minimally invasive parathyroidectomy: a combination of sestamibi-SPECT localization, cervical block anaesthesia, and intraopertive parathyroid hormone assay. Surgery 1999;126:1016-22. [CrossRef]
12. Lo Gerfo P, Ditkoff BA, Chabot J, Feind C. Thyroid surgery using monitored anaesthesia care: an alternative to general anaesthesia. Thyroid 1994;4:437-9. [CrossRef]
13. Ramsay MAE, Savege TM, Simpson BRJ & Goodwin R. Controlled sedation with alpaxalone-alphadolone. Br Med J 1974;2:656-9. [CrossRef]
14. Marohn MR, LaCivita KA. Evaluation of total/near total thyroidectomy in a short-stay hospitalization: safe and cost-effective. Surgery 1995;118:943-8. [CrossRef]
15. McHenry CR. “Same-day” thyroid surgery: an analysis of safety, cost savings, and outcome. Am Surg 1997;63:586-90.
16. Foster RS Jr. Morbidity and mortality after thyroidectomy. Surg Gynecol Obst 1978;146:423-9.
17. Burkey SH, van Heerden JA, Thompson GB, Grant CS, Schleck CD, Farley DR. Reexploration for symptomatic hematomas after cervical exploration. Surgery 2001;130:914-20. [CrossRef]
18. Lacoste L, Gineste D, Karayan J, Montaz N, Lehuede MS, Girault M, et al. Airway complications in thyroid surgery. Ann Oto Rhino Laryngol 1993;102:441-6.
19. Abbas G, Dubner S, Heller KS. Re-operation for bleeding after thyroidectomy and parathyroidectomy. Head Neck 2001;23:544- 6. [CrossRef]
20. Sonner JM, Hynson JM, Clark O, Katz JA. Nausea and vomiting following thyroid and parathyroid surgery. J Clin Anaesth 1997; 9:398-402. [CrossRef]
21. Rosenbaum MA, Haridas M, McHenry CR. Life-threatening neck haematoma complicating thyroid and parathyroid surgery. Am J Surg 2008;195:339-43. [CrossRef]