Parathyroid surgery: Anesthesia
What are my choices for anesthesia?
Parathyroid surgery can be done with local anesthesia or general anesthesia. The options available will depend on the surgeon's and the anesthesiologist's experience and comfort. In addition, the patient's medical history (such as acid reflux, sleep apnea, claustrophobia) may help decide which anesthesia is safe and appropriate.
General anesthesia involves giving intravenous (IV) or inhaled medications which put the patient into a deep sleep and an endotracheal tube (breathing tube) or an LMA (laryngeal mask airway) is used to help breathe for the patient during the operation. An LMA uses a special tube that sits above the vocal cords. Most patients tolerate general anesthesia very well and it is considered very safe. The most common side effect are a sore throat and nausea. There are many medications that can be given to help prevent or reduce the nausea.
The local anesthesia technique uses a nerve block to numb the neck so that the patient does not feel any sharp pain and is usually combined with light sedation similar to the "twilight" of colonoscopy. The nerve block typically uses a combination of Lidocaine (short acting) and Marcaine (long acting) local anesthetics or "numbing" medication. Light sedation with any of a number of intravenous (IV) medications may be given to make the patient more comfortable and to help them not remember the operation. Sedation can be very light (just enough to help the patient relax) or heavy (where the patient is in a fairly deep sleep). In some cases, the operation may done with the patient awake and aware during surgery. The benefits of local anesthesia include, less post-operative nausea, less of a sore throat, a slightly decreased risk of vocal irritation and temporary hoarseness, and the ability to monitor the patient's voice by talking to them during the operation. Approximately 10% of patient who start off with a local anesthesia need to be converted to a general anesthesia because either they are not comfortable or are moving around too much during the operation. Patients with claustrophobia, panic or severe anxiety disorders, and sleep apnea may not be eligible for this type of anesthesia.