Total thyroidectomy for giant goiter under local anesthesia and Ketamine in a surgical mission. (2015)

• Record Type: Journal Article
• Authors: Latifi, Rifat; Harper, Joan; Rivera, Renato
• Is Part Of: International journal of surgery case reports. Volume 8(2015)
• Page Start: 52
• Page End: 54
• Publication Date: 2015
• Subjects: Total thyroidectomy -- Difficult airway -- Surgical mission -- Ketamine -- Unable to intubate; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2015.01.007
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Total thyroidectomy for giant goiters can be done under local anesthesia and should be an option to be reserved for most difficult cases and when airway cannot be secured. Surgeons and anesthesiologists participating in surgical missions may have to perform major surgery under local anesthesia. Close cooperation of the surgical team is manadatory. Abstract: Background: 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. Materials and methods: 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. Results: 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 4 mm. Patient tolerated the procedure well and had no postoperative complication. Her breathing improved significantly post-operatively. Five years later, she is doing well. Conclusion: 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.