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General and regional anaesthesia for the thyroidectomy in rural/semi-urban Nigerian centres
Abstract
Objective: To evaluate the feasibility and benefits of regional anaesthesia (RA) for thyroidectomy in rural/semi-urban centres.
Design: A prospective study.
Settings: Missionary Hospital Saki,Nigeria and Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria.
Subjects: One hundred and seventy five patients with goitre.
Results: The average time for the anaesthetists to put patients to sleep was 4.06±1.02 minutes, while it took 17.8±2.9 minutes to give the regional block. Post operative laryngeal complications in RA group were very minimal, while in general anaesthesia (GA) group, there were significant complications in 32 (36%) patients laryngeal oedema 15 (17%), erosions in 10 (11%) and ulcer in seven (8%). Cost of surgery in GA was thrice as much as in RA group. Thirty one (35%) with GA had steam inhalation for sore throat. It was possible to converse (laryngeal nerve monitoring) with the patient during operation but not possible with GA group. There was early discharge of patients in RA group.
Conclusion: Regional/local anaesthesia is feasible for some cases of thyroidectomy with a lot of advantages and specifically allows surgeons to converse with the patients during operation -direct laryngeal and other nerve monitoring. Despite advancement in cuff design a lot of lesions still occur from endotracheal intubations.
Design: A prospective study.
Settings: Missionary Hospital Saki,Nigeria and Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria.
Subjects: One hundred and seventy five patients with goitre.
Results: The average time for the anaesthetists to put patients to sleep was 4.06±1.02 minutes, while it took 17.8±2.9 minutes to give the regional block. Post operative laryngeal complications in RA group were very minimal, while in general anaesthesia (GA) group, there were significant complications in 32 (36%) patients laryngeal oedema 15 (17%), erosions in 10 (11%) and ulcer in seven (8%). Cost of surgery in GA was thrice as much as in RA group. Thirty one (35%) with GA had steam inhalation for sore throat. It was possible to converse (laryngeal nerve monitoring) with the patient during operation but not possible with GA group. There was early discharge of patients in RA group.
Conclusion: Regional/local anaesthesia is feasible for some cases of thyroidectomy with a lot of advantages and specifically allows surgeons to converse with the patients during operation -direct laryngeal and other nerve monitoring. Despite advancement in cuff design a lot of lesions still occur from endotracheal intubations.
