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What Kind Of Anesthesia Is Used For Thyroid Surgery

Physician Volume And Expertise

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Keep in mind, as well, that the likelihood of a complication occurring is much less with an experienced surgeon. With this in mind, it’s a good idea to ask your surgeon how many thyroidectomies she has performed in the past. You may also wish to ask about her complication rate, but this is not necessarily an accurate measure of competence .

Neck Pain And Stiffness

The neck is put in an extended position during surgery, and many people avoid moving their necks afterward. This can lead to neck pain and stiffness. Using pain medication after surgery may reduce discomfort, making it easier for you to keep moving your neck so that you have less stiffness later on. Applying a warm compress may also help.

Many surgeons recommend doing gentle stretching and range-of-motion exercises, such as the following, to reduce stiffness. Before doing these, however, make sure to ask your surgeon about their appropriateness for you, any additional exercises she believes might be helpful, how often you should perform them, and whether there are any exercises you should avoid.

  • Gently turn your head to the right, then roll your head so that you are looking at the floor, then gently roll your head to the left.
  • Gently tilt your head to the right and then to the left.
  • Rotate both shoulders forward in a circular motion.
  • Slowly raise your arms overhead, and then slowly lower them back down against your body.

Suggested frequency: 10 repetitions, three times day

Most often, neck stiffness lasts for only a few days to a few weeks after surgery. If yours does not, talk to your surgeon about seeing a specialist in physical medicine and rehabilitation or a physical therapist who can work with you to improve the flexibility of your neck and design an exercise program to restore your neck mobility to normal.

Investigations And Lab Findings

Routine investigations should include hemoglobin , white blood cell count, platelet count, serum electrolytes including serum calcium, thyroid function tests, renal function tests, chest X-ray, X-ray antero-posterior and lateral view of neck and ECG .

Lateral view of neck X-ray showing the compression of trachea from a longstanding enlarged goiter

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Days Before Your Surgery

Follow your healthcare providers instructions for taking aspirin

If you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Aspirin can cause bleeding.

Follow your healthcare providers instructions. Dont stop taking aspirin unless they tell you to. For more information, read the resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs , or Vitamin E.

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements

Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your surgery. These things can cause bleeding. For more information, read the resource Herbal Remedies and Cancer Treatment.

Thyroidectomy Surgery Procedure Types

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Traditional Thyroidectomy Surgery In this procedure, the surgeon makes a 3 to 5 inch incision across the base of the patients neck in the front. The skin and muscles are pulled back to expose the thyroid gland. The incision is usually made so that it falls in the fold of the patients skin, making it less noticeable. Blood supply to the gland is tied off and the parathyroid glands are identified, so that they can be properly protected. The surgeon then separates the trachea from the thyroid, and removes all or part of the gland.

Endoscopic Thyroidectomy Surgery Endoscopic Thyroid Surgery is quite new and involves using a small magnifying camera which is inserted into the neck via a small incision. Carbon dioxide is pumped into the neck area to help the surgeon see the area easily and perform the surgery. A second small incision is made, and a thin tube with a scalpel-like edge is inserted. This tube is the surgical tool that is used to remove the thyroid. Endoscopic surgery, because it involves two small scars of less than one inch, usually leaves less visible scarring, and allows a quicker return to normal activity.

Post surgery, the patient remains under observation in the hospital for around 6 hours. Depending upon the requirement, however, the patient may be asked to stay overnight.

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Whats The Difference Between A Partial And Total Thyroidectomy

The extent of your thyroid surgery should be discussed by you and your thyroid surgeon and can generally be classified as a partial thyroidectomy or a total thyroidectomy. Removal of part of the thyroid can be classified as: An open thyroid biopsy a rarely used operation where a nodule is excised directly

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There are several different surgical procedures involving the thyroid, and your diagnosis will determine which one is appropriate for you. For the best outcome, it is important to find an experienced, top-notch thyroid surgeonone that has not only performed your procedure but has done it many times, among other qualifications.

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What Are The Risks Of Surgery

As with any surgical procedure, thyroidectomy has associated risks. Although the chance of a complication occurring is small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have.

1) BLEEDING: Minimal bleeding is expected during and after thyroid surgery. Minor bleeding from the incision is typically not a problem however, heavy bleeding deeper in the neck can be serious and can potentially cause difficulty with breathing.

2) HYPOPARATHYROIDISM OR LOW BLOOD CALCIUM: The parathyroid glands are small glands located around the thyroid gland. There are 4 parathyroid glands and these glands regulate the body’s calcium level. Every attempt is made to identify and preserve these glands during surgery. Temporary or permanent drops in calcium levels can occur following complete removal of the thyroid. Your calcium levels will be monitored in the hospital and replacement given if levels are low.

3) DAMAGE TO THE NERVES THAT MOVE THE VOCAL CORDS:

4) INFECTION: Infection after thyroid surgery is uncommon but is most commonly treated with antibiotics or drainage.

5) POSSIBLE NEED FOR FURTHER TREATMENT AND/OR SURGERY: Once your thyroid is removed it will be sent to the lab to be examined by a pathologist. If a cancer is noted, further surgery or treatment may be necessary. This will be discussed with you by your surgeon.

Caring For Your Incision

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Your surgeon will talk to you about whether you should continue to wear a dressing over your incision. Depending on the surgeon, you may have stitches that will need to be removed or absorbable sutures that will not. If steri-strips were applied, these will usually stay in place for around a week. Most surgeons recommend leaving these alone until they fall off by themselves, rather than trying to remove them.

You will probably be able to shower, but should try to keep your neck as dry as possible. You should not submerge, soak, or scrub your incision, and bathing in a tub should be avoided until you see your surgeon. After showering, you can lightly pat your neck dry or use a hair dryer set on the “cool” setting.

Your incision may appear red and hard at first, and you may notice some slight swelling and bruising around the scar. If you experience itching, applying scar gel or aloe may provide relief, but talk to your surgeon before doing so. The hardening typically peaks about three weeks after surgery and then subsides over the next two to three months.

In time, your incision will turn pink and then white, and most are completely healed in six to nine months.

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Demographic Anthropometric And Clinical Characteristics Of Participants

A total of 74 patients were involved. The demographic, anthropometric and clinical characteristics of participants were found comparable between the groups . Sub-total and near total thyroidectomy were the leading types of thyroid surgery in the block group and non-block group respectively. The length of incision was 9.2±2.8 vs 9.1±2.1 in the block group and non-block group respectively and no statistically significant difference between the groups. Simple nodular goiter was the most frequent diagnosis in the block group and multi-nodular goiter in the non-block group . Only 4 patients had undergone extended neck dissection. The use of preemptive analgesia with simple analgesics and opioids was comparable. There was no difference in choices of induction agents. The larger proportions of patients in both groups were induced with propofol and the remaining with thiopentone.

Table 1 Demographic and clinical characteristics of patients, frequency and percentage ) from Chi square test, mean±standard deviation from independent t-test, N=74

How Much Of My Thyroid Will Be Removed

That depends on your condition and your doctor’s advice. When the entire thyroid is removed, the operation is called a total thyroidectomy. You will need thyroid hormone replacement for life. A thyroid lobectomy or hemithyroidectomy is when half the thyroid is removed. In most instances , the remaining half can make enough thyroid hormone and you will not need tablets.

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What Laboratory Tests Should Be Obtained And Has Everything Been Reviewed

The surgeon will order and review diagnostic thyroid ultrasound or other imaging study if indicated. The surgeon will also check thyroid function and calcium levels.

a. Hemoglobin levels:

Check hemoglobin if indicated.

i. Indications for transfusion: The decision to transfuse is based upon comorbidities/end organ damage, signs or symptoms of inadequate oxygen carrying capacity, presence of anaerobic glucose metabolism, as seen by lactic acidosis, continued blood loss, and blood pressure unresponsive to vasopressors.

I. Patients with end organ disease are often transfused below euvolemic hemoglobins of 10 to optimize oxygen carrying capacity to the organs.

II. pRBC transfusion is otherwise indicated for inadequate oxygen carrying capacity. Clinical assessment of cerebral and cardiac organs includes mental status, drowsiness, angina, arrhythmias, EKG changes, and hypotension.

b. Electrolytes

i. Potassium: Patients on potassium wasting diuretics or hemodialysis may have abnormalities.

ii. Sodium: Dehydration.

iii. BUN/Creatinine: Check if indicated ratio greater than 20:1 often suggests hypovolemia.

c. Coagulation panel:
d. Imaging:

Check if indicated. Thyroid function tests discussed above.

Common laboratory normal values will be same for all procedures, with a difference by age and gender.

Minimally Invasive Thyroid Surgery

Types of Anesthesia Used During Surgery

The typical incision made for thyroid surgery is known as a “collar incision” in which a large incision is made stretching from one side of the neck to the other just above the collar bone. Minimally invasive thyroid surgery refers to certain types of surgery in which the thyroid is removed through very small incisions using special techniques. Columbia Thyroid Center surgeons perform minimally invasive thyroid surgery in over 95% of patients, typically using an incision measuring just an inch to an inch and a half in length. In addition to using very small incisions, our surgeons “hide” the incision in a natural skin crease which acts like camouflage. Most people will not be able to notice the incision once the redness fades away. See our Scar Gallery section for examples of minimally invasive thyroid surgery.

At the Columbia Thyroid Center, 95% of our patients are able to go home after a 4 hour observation period in the recovery room. In certain cases, a patient may be asked to spend the night in the hospital. Patients who are asked to stay overnight generally have very large goiters, advanced cancer, bleeding disorders, a history of taking anticoagulation, or have a personal preference to spend the night. Patients who spend the night in the hospital are typically discharged by 10AM the next morning.

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Local Anesthesia And Cervical Plexus Block

Thyroidectomy under local and regional anesthesia typically is accompanied by mild intravenous sedation. Generally, local anesthesia without cervical plexus block is limited to central thyroid resections, for example isthmusectomy. Although more extensive thyroid resections can be performed under strict local anesthesia, adjuvant cervical plexus blocks facilitate deeper dissection and reduce the need for repeated injections of local anesthetic during the operation .

The superficial cervical plexus innervates the skin of the anterolateral neck through anterior primary rami of C2 through C4 and emerges as four distinct nerves from the posterior border of the sternocleidomastoid muscle the transverse branches of the plexus primarily innervate the thyroid gland parenchyma . Several surface anatomy landmarks are also helpful for estimating the location of injection at the posterior border of the sternocleidomastoid muscle: the mastoid process, the tubercle of C6, and the posterior border of the clavicular head of the sternocleidomastoid muscle. A line extending from the mastoid to C6 may be drawn the site of needle insertion is the midpoint of this line.

The target depth of the cervical block is the tissue between the investing fascia and the deep cervical fascia, which envelops the vertebral column and cervical nerve roots. The pretracheal fascia contains the thyroid gland and the recurrent and superior laryngeal nerves .

Fig. 1

Patient Selection And Preoperative Evaluation

Patient selection is an important component of any procedure, and thyroidectomy under locoregional anesthesia is no exception. Patients who are unable to communicate or who are not cooperative are poor candidates. Other contraindications include large goiter, previous neck surgery, sleep apnea, coagulopathy, severe claustrophobia or anxiety, morbid obesity, preoperative recurrent laryngeal nerve paralysis, retro-esophageal or retro-tracheal goiter, need for sternotomy, concomitant cervical lymphadenopathy, known or suspected locally-invasive cancer, patient preference for general anesthesia, and allergy to local anesthesia. However, some studies have revealed that indications may be extended with increased surgeon and anesthesiologist experience . The surgeon and anesthesiologist must also be prepared to convert to general anesthesia at any time during the procedure, and to do so in a controlled and safe fashion. Reasons for conversion from cervical plexus block to general anesthesia include unexpected intraoperative pathology, patient discomfort, and toxic reaction to lidocaine .

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What The Anesthesiologist Should Know Before The Operative Procedure

Disorders of the thyroid gland usually involve some swelling or increase in thyroidal tissue. Surgery is typically superficial and in some cases can be performed under regional or local anesthesia by experienced surgeons.

The thyroid gland can become massive and sternotomy may be required to extirpate the gland. Often considered a minor operation, many patients may go home the same day. There is increasing tendency to perform these surgeries with video or robotic assistance.

The basic indication for thyroidectomy is to remove thyroid cancer. Most patients present with a simple thyroid nodule and are euthyroid. Additional indications include removal of thyroid nodules, managing hyperthyroidism, and relieving obstructive goiter.

Operations include thyroid lobectomy, lobectomy plus isthmusectomy, total thyroidectomy, central or lateral lymph node dissection, and radical neck dissection. Surgery is also performed for toxic multinodular goiter and to remove a functioning thyroid adenoma. Partial thyroid lobectomy and subtotal thyroidectomy are no longer performed.

It is important to know the anatomy of the thyroid gland, especially as it relates to the anatomical course of the recurrent laryngeal nerves. One or both of these nerves may be injured as they travel in the tracheoesophageal groove and run along the medial surface of each thyroid lobe.

What You Need To Know

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  • Thyroid cancer, thyroid nodules and other conditions may require thyroidectomy.
  • Once the thyroid gland is removed, the person takes replacement thyroid hormone to keep the bodys functions in balance.
  • Thyroidectomy can be performed through an incision at the front of the neck, or through the mouth .

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Day Before Your Surgery

Note the time of your surgery

A staff member from the Admitting Office will call you after 2:00 pm the day before your surgery. If your surgery is scheduled for a Monday, theyll call you on the Friday before. If you dont get a call by 7:00 pm, call .

The staff member will tell you what time to arrive at the hospital for your surgery. Theyll also remind you where to go.

This will be one of the following locations:

  • Josie Robertson Surgery Center

Instructions for eating before your surgery

Do not eat anything after midnight the night before your surgery. This includes hard candy and gum.

What Are The Types Of Dental Anesthetics

Anesthesia means a lack or loss of sensation. This can be with or without consciousness.

Today there are many options available for dental anesthetics. Medications can be used alone or combined for better effect. Its individualized for a safe and successful procedure.

The type of anesthetics used also depends on the age of the person, health condition, length of the procedure, and any negative reactions to anesthetics in the past.

Anesthetics work in different ways depending on whats used. Anesthetics can be short-acting when applied directly to an area or work for longer times when more involved surgery is required.

The success of dental anesthesia depends on:

  • the drug

Research also shows that inflammation can have a negative impact on the success of anesthetics.

Also, for local anesthesia, teeth in the lower jaw section of the mouth are harder to anesthetize than the upper jaw teeth.

There are three main types of anesthesia: local, sedation, and general. Each has specific uses. These can also be combined with other medications.

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Minimally Invasive Parathyroid Surgery With General Anesthesia

When patients are having complex parathyroid surgery, as in revision surgery or when the parathyroid is in the chest, or when patients are anxious and are not comfortable with having surgery under local anesthesia, general anesthesia is used. General anesthesia involves having the patient fully asleep with a breathing tube in the throat. The length of surgery is the same, however, it usually takes some time for patients to fully awake from this type of anesthesia and therefore the length of time in recovery room is slightly longer. The success of surgery and the recovery of surgery is generally the same as when done under loco-regional anesthesia.

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