Latifi Rifat, Harper Joan, Rivera Renato
Department of Surgery, University of Arizona, Tucson, AZ, USA.
Chandler Anesthesia Consultants, Gilbert, AZ, USA.
Int J Surg Case Rep. 2015;8C:52-4. doi: 10.1016/j.ijscr.2015.01.007. Epub 2015 Jan 13.
Operation Giving Back (OGB) of the American College of Surgeons (ACS) and various other surgical missions in the developing world have become more popular and provide a valuable way of reducing the surgical burden worldwide. While most cases are "bread and butter" general surgery, difficult surgeries are often encountered.
Description of a total thyroidectomy for super giant goiter extending to chest inferiorly, lateral neck and behind both ears, compressing the trachea and causing chronic difficulties breathing. The surgical team was unable to intubate, but performed surgery under local anesthesia and sedation with Ketamine injection.
Total thyroidectomy, as a life-saving procedure, was performed under local anesthesia and Ketamine with mild sedation. Once thyroid was removed, the outside diameter of trachea was assessed to be 4mm. Patient tolerated the procedure well and had no postoperative complication. Her breathing improved significantly post-operatively. Five years later, she is doing well.
Total thyroidectomy for giant goiters can be done under local anesthesia with Ketamine and proper sedation. Surgeons and anesthesiologists participating in surgical missions may have to perform major surgery under local anesthesia.
美国外科医师学会（ACS）的“回馈行动”（OGB）以及在发展中国家开展的其他各种外科手术任务越来越受欢迎，为减轻全球外科负担提供了一种宝贵途径。虽然大多数病例是普通外科的常见手术，但也经常会遇到复杂手术。
描述了一例针对向下延伸至胸部、侧颈部及双耳后方、压迫气管并导致慢性呼吸困难的超级巨大甲状腺肿进行的全甲状腺切除术。手术团队无法进行插管，但在局部麻醉并注射氯胺酮镇静的情况下实施了手术。
作为一项挽救生命的手术，全甲状腺切除术在局部麻醉和氯胺酮轻度镇静下完成。甲状腺切除后，测得气管外径为4毫米。患者对手术耐受性良好，无术后并发症。术后其呼吸明显改善。五年后，她状况良好。
巨大甲状腺肿的全甲状腺切除术可在局部麻醉下使用氯胺酮并适当镇静完成。参与外科手术任务的外科医生和麻醉医生可能不得不于局部麻醉下进行大手术。
