General or Local Anaesthesia in One-Day Thyroid Surgery-Does It Matter?

Abstract

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<0.001). Patient satisfaction was similar but the operator preference was greater for GA. Conclusion:In experienced hands LA with MAC for Thyroidectomy is a safe and wise choice, but GA is even more so!

Local anesthesia with monitored anesthesia care for patients undergoing thyroidectomy: a case series

“…We did not compare our cases with thyroidectomy under general anesthesia, so we cannot be certain that local anesthesia with MAC is superior to general anesthesia during thyroidectomy. However, the incidence of postoperative complications was similar to that of general anesthesia or local anesthesia with MAC compared to previous studies [239]. …”

“…Snyder et al [3], reported about patients who received local anesthesia with MAC and boluses of midazolam, propofol, or fentanyl citrate for supplemental analgesia. Another study administered incremental doses of midazolam and fentanyl citrate to patients under MAC with regional anesthesia only when required [2]. The total and maintenance doses of the drugs were not reported in either study.…”

“…Recent reports have demonstrated that both of general and local anesthesia with MAC can be used for thyroidectomy due to similar clinical outcomes, perioperative complications, and patient satisfaction [238]. Although no significant differences were observed in the number of nausea episodes between the general and local anesthesia groups, the general anesthesia group required more antiemetics than the local anesthesia group [3].…”

“…Although no significant differences were observed in the number of nausea episodes between the general and local anesthesia groups, the general anesthesia group required more antiemetics than the local anesthesia group [3]. Moreover, patients receiving local anesthesia with MAC spent less time in the PACU and daycare center, leading to early discharge [23]. We did not compare our cases with thyroidectomy under general anesthesia, so we cannot be certain that local anesthesia with MAC is superior to general anesthesia during thyroidectomy.…”

“…This survey shows that patients suffer much more from general anesthesia than previously believed. Several additional recent studies have reported that thyroid surgery can be safely performed under local, regional anesthesia, and general anesthesia [23]. However, no official reports of thyroidectomy under local/regional anesthesia with monitored anesthesia care (MAC) have been published in Korea.…”