Makovac P, Potié A, Roukain A, Pucci L, Rutz T, Kopp P A, Matter M
Department of Visceral Surgery, University Hospital of Lausanne and University of Lausanne Switzerland.
Department of Anesthesiology, University Hospital of Lausanne and University of Lausanne Switzerland.
Int J Surg Case Rep. 2020;72:133-136. doi: 10.1016/j.ijscr.2020.05.078. Epub 2020 Jun 6.
Total thyroidectomy can be challenging in high-risk patients. Local cervical anesthesia with sedation is an alternative to general anesthesia.
A 33-year old male patient with cyanotic congenital heart disease due to unrepaired tricuspid atresia type Ic and associated pulmonary arterial hypertension presented with tachycardic atrial fibrillation and amiodarone-induced thyrotoxicosis resulting in recurrent hemodynamic instability. Because of difficulties controlling the thyrotoxic state, the indication for total thyroidectomy was established. Total thyroidectomy was subsequently performed using local anesthesia combined using a hypnosis-analgesia technique instead of intravenous sedation. The intervention and the post-operative course were uneventful.
A well-established therapist-patient relationship is crucial for a successful induction of hypnosis. Patient motivation and expectations are equally important for a successful implementation of this approach.
We conclude that hypnosis combined with local anesthesia provides an effective alternative in selected patients with very high anesthesiological risk.
对于高危患者，全甲状腺切除术可能具有挑战性。局部颈部麻醉联合镇静是全身麻醉的一种替代方法。
一名33岁男性患者，因未修复的Ic型三尖瓣闭锁及相关肺动脉高压患有紫绀型先天性心脏病，出现心动过速性心房颤动和胺碘酮诱发的甲状腺毒症，导致反复血流动力学不稳定。由于难以控制甲状腺毒症状态，确定了全甲状腺切除术的指征。随后采用局部麻醉联合催眠镇痛技术而非静脉镇静进行了全甲状腺切除术。手术过程及术后恢复顺利。
建立良好的治疗师 - 患者关系对于成功诱导催眠至关重要。患者的动机和期望对于该方法的成功实施同样重要。
我们得出结论，催眠联合局部麻醉为选定的具有极高麻醉风险的患者提供了一种有效的替代方法。
