Carling Tobias, Donovan Patricia, Rinder Christine, Udelsman Robert
Yale University School of Medicine, New Haven, CT 06510, USA.
Arch Surg. 2006 Apr;141(4):401-4; discussion 404. doi: 10.1001/archsurg.141.4.401.
We investigated the frequency and reasons for conversion from cervical block anesthesia to general anesthesia (GA) in patients undergoing minimally invasive parathyroidectomy for primary hyperparathyroidism.
Prospective case series.
Tertiary university hospital.
A total of 441 consecutive patients with primary hyperparathyroidism undergoing minimally invasive parathyroidectomy under cervical block and monitored anesthesia care using midazolam and narcotics were included. Patients with known multiglandular, familial, or secondary hyperparathyroidism or noninformative preoperative localization or those electing minimally invasive parathyroidectomy under GA were excluded.
All patients underwent cervical block anesthesia and focused exploration using minimally invasive techniques.
Intraoperative need for conversion from cervical block anesthesia to general endotracheal anesthesia.
Of the 441 patients, 47 (10.6%) required conversion to GA. In all instances, conversion was performed in a controlled fashion using neuromuscular blockade, endotracheal intubation, and maintenance of the original surgical field preparation. Sixteen procedures were converted to accomplish simultaneous thyroid resections. An additional 15 were converted because the intraoperative parathyroid hormone level failed to decrease by at least 50% from the baseline after resection of the incident parathyroid tumor and extensive exploration was required. Eight procedures were converted because of technical difficulties related to ensuring adequate protection of the recurrent laryngeal nerve. Five procedures were converted to optimize patient comfort, and 2 were converted because of the intraoperative recognition of parathyroid carcinoma. One patient experienced a toxic reaction to lidocaine, causing a seizure.
The vast majority of minimally invasive parathyroidectomies can be performed using cervical block anesthesia. However, conversion to GA is appropriate when unexpected intraoperative findings are encountered or for patient comfort.
我们调查了因原发性甲状旁腺功能亢进症接受微创甲状旁腺切除术的患者从颈丛阻滞麻醉转换为全身麻醉（GA）的频率及原因。
前瞻性病例系列研究。
三级大学医院。
共有441例连续的原发性甲状旁腺功能亢进症患者，在颈丛阻滞及使用咪达唑仑和麻醉性镇痛药的监护麻醉下接受微创甲状旁腺切除术。已知有多发性腺体、家族性或继发性甲状旁腺功能亢进症，或术前定位不明确，或选择在全身麻醉下进行微创甲状旁腺切除术的患者被排除。
所有患者均接受颈丛阻滞麻醉，并采用微创技术进行重点探查。
术中从颈丛阻滞麻醉转换为全身气管内麻醉的必要性。
441例患者中，47例（10.6%）需要转换为全身麻醉。在所有情况下，转换均以可控方式进行，采用神经肌肉阻滞、气管插管，并维持原手术野准备。16例手术转换是为了同时进行甲状腺切除术。另外15例转换是因为切除甲状旁腺肿瘤后术中甲状旁腺激素水平未能从基线至少下降50%，需要进行广泛探查。8例手术转换是因为在确保充分保护喉返神经方面存在技术困难。5例手术转换是为了优化患者舒适度，2例转换是因为术中发现甲状旁腺癌。1例患者对利多卡因发生毒性反应，引发癫痫发作。
绝大多数微创甲状旁腺切除术可采用颈丛阻滞麻醉进行。然而，当遇到意外的术中发现或为了患者舒适度时，转换为全身麻醉是合适的。
