Chang Michael, Coughran Alanna, Lee Yu-Jin, Collins Jeremy, Sirjani Davud
Department of Otolaryngology-Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA, USA 94305.
Department of Otolaryngology-Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA, USA 94305; Department of Health Research and Policy, Stanford University, Stanford, CA 94305, USA.
Am J Otolaryngol. 2019 Mar-Apr;40(2):152-155. doi: 10.1016/j.amjoto.2019.01.002. Epub 2019 Jan 14.
To report the patient selection, surgical technique, and outcomes of parotidectomy using local anesthesia under monitored anesthesia care (MAC).
A retrospective chart review was performed for patients undergoing parotidectomy under local anesthesia at an academic head and neck surgery center.
Six patients deemed high risk for general anesthesia (GA) due to medical comorbidities or with a strong preference to avoid GA underwent parotidectomy using local anesthesia and MAC. Parotidectomy was performed for several indications, including benign tumors, malignant tumors, and chronic sialadenitis. Mean age of patients was 78.0 ± 7.9 years, and all had an American Society of Anesthesia score ≥ 2 and Charlson comorbidity index ≥4. Mean operative time was 102.8 ± 38.3 min, comparable to that of parotidectomy under general anesthesia. No major complications occurred. Minor complications included three cases of temporary postoperative facial nerve weakness limited to 1-2 lower division branches. At most recent follow up (10 to 48 months), all patients were medically stable and disease free.
In carefully selected patients, parotidectomy under local anesthesia is a viable treatment alternative that can be offered to patients. Successful outcomes require preoperative counseling, meticulous technique, and close collaboration with anesthesia colleagues.
报告在监护麻醉（MAC）下采用局部麻醉进行腮腺切除术的患者选择、手术技术及结果。
对在一家学术性头颈外科中心接受局部麻醉下腮腺切除术的患者进行回顾性病历审查。
6例因内科合并症被视为全身麻醉（GA）高风险或强烈倾向于避免全身麻醉的患者接受了局部麻醉联合MAC下的腮腺切除术。腮腺切除术有多种适应证，包括良性肿瘤、恶性肿瘤和慢性涎腺炎。患者平均年龄为78.0±7.9岁，所有患者美国麻醉医师协会评分≥2且查尔森合并症指数≥4。平均手术时间为102.8±38.3分钟，与全身麻醉下腮腺切除术的时间相当。未发生重大并发症。轻微并发症包括3例术后暂时性面神经麻痹，仅限于1 - 2个下部分支。在最近一次随访（10至48个月）时，所有患者病情稳定且无疾病。
在经过仔细挑选的患者中，局部麻醉下的腮腺切除术是一种可行的治疗选择，可以提供给患者。成功的结果需要术前咨询、细致的技术操作以及与麻醉科同事密切合作。
