Local/Cervical Block Anesthesia versus General Anesthesia for Minimally Invasive Parathyroidectomy: What are the Advantages?

Background Minimally invasive parathyroidectomy (MIP) under local/cervical block anesthesia (LA) is safe and effective for patients with primary hyperparathyroidism (HPT). Advantages of LA versus general anesthesia (GA) for these focused procedures have not been clearly demonstrated. Methods Between 3/01 and 6/04, 177 consecutive patients with primary HPT and positive localization studies underwent MIP. Seventy-three (41%) had surgery under LA while 104 (59%) had GA. Primary endpoints were IV narcotic use, anti-emetic use, nausea, vomiting, and post-operative pain. Results Patients who had parathyroidectomy under LA were older (64 ± 2 vs. 57 ± 2 years, P = 0.001). Cure and complication rates were identical between the two groups. Patients who had parathyroidectomy under LA required less IV narcotic pain mediation (mean morphine equivalents 11.4 ± 1.3 mg vs. 22.5 ± 1.1 mg; P < 0.001) compared to GA patients. The LA patients had better pain control as shown by lower post-operative peak pain scores (2.9 ± 0.3 vs. 5.0 ± 0.4; P < 0.001) and lower overall pain scores (mean 1.9 ± 0.2 vs. 3.1 ± 0.2; P < 0.001). The LA group required fewer anti-emetic medications compared to the GA patients (mean 0.4 ± 0.1 vs. 1.7 ± 0.1 doses; P < 0.001). Fewer LA patients experienced post-operative nausea (16% vs. 49%; P < 0.001), and vomiting (7% vs. 24%; P = 0.002). Length of stay was similar between the groups (0.4 ± 0 vs. 0.3 ± 0; P = 0.22). Conclusions In this study the choice of anesthesia did not affect surgical cure rate, morbidity, or length of stay. LA was associated with significantly lower post-operative pain, nausea, and vomiting. LA appears to offer specific advantages more than GA for patients undergoing MIP. This study was presented at the 59th Annual Meeting of the Surgical Society of Oncology, San Diego, CA, USA, March 23–26 2006     

Anesthesia for oncogenic osteomalacia—A rare paraneoplastic syndrome

Two patients with a diagnosis of oncogenic osteomalacia are described. This rare disease, characterized by secretion of fibroblast growth factor-23 by the tumor cells, causes myopathy, extreme debilitation and severe osteopathy because of severe hypophosphatemia. Both patients presented with severe bone pain, pathological fractures and proximal muscle weakness. Multiple diagnostic tools had to be utilized to settle the diagnosis of this rare disease. Although supplemental therapy for hypophosphatemia is usually started preoperatively, surgical excision of the causative tumor is the only definite treatment. Surgery is almost always curative; however, there is a lack of discourse in the literature regarding the anesthetic implications for the disease. The complete pathophysiology of the disease, clinical picture, its diagnostic intricacies as well as the salient points in its anesthetic management are discussed in this report.     

Anesthesia in breast feeding. Which restrictions are justified?

In the last years knowledge of the excretion of drugs into breast milk has increased significantly. But information concerning anesthetic and analgesic drugs seems to be dispersed and limited. This paper describes the pharmacokinetic principles of drug transfer to milk and offers a comprehensive survey for drugs used in the perianesthetic period. The necessity of anesthesia should never be a sufficient reason to quit breast-feeding. With the information given in this article the individual duration of breast-milk-free interval can be discussed. Thus it will be possible to anesthetize a breast-feeding mother with minimal risks for the child without giving up the advantages of mother milk. Through careful selection of appropriate drugs even elective operations don't need to be postponed and breastfeeding can be continued as soon as in the immediate postoperative period.     

Guidelines to the Practice of Anesthesia – Revised Edition 2019

Canadian Journal of Anesthesia/Journal canadien d'anesthésie - The Guidelines to the Practice of Anesthesia Revised Edition 2019 (the Guidelines) were prepared by the Canadian...