piperidines and Parathyroid-Neoplasms

Topics: Aged, 80 and over; Androstanols; Anesthesia, Intravenous; Anesthetics, Intravenous; Carcinoma, Squamous Cell; Delayed Emergence from Anesthesia; Dermatomyositis; Disease Susceptibility; Female; Humans; Intraoperative Complications; Neuromuscular Nondepolarizing Agents; Parathyroid Neoplasms; Parathyroidectomy; Piperidines; Pneumonia, Aspiration; Preanesthetic Medication; Propofol; Remifentanil; Risk; Rocuronium

The brachial plexus block, either deep or superficial, is one of the anesthetic techniques used in parathyroidectomy. The block is easy to perform and has few hemodynamic side effects. Surgery can be carried out in an awake patient. We describe 3 cases of patients with primary hyperparathyroidism (parathyroid adenoma) who underwent unilateral minimally invasive parathyroidectomy under regional anesthesia and sedation with 2 mg of midazolam plus remifentanil at dosages ranging from 0.6 to 0.1 microg kg(-1) min(-1). To provide a deep cervical block, we administered 15 mL of 0.75% ropivacaine. For a superficial block, 15 mL of 0.2% ropivacaine was used. The procedure could be completed in all 3 patients under regional anesthesia. The latency time for the block ranged from 21 to 30 minutes, and remifentanil dosages from 0.05 to 0.09 microg kg(-1) min(-1) were administered for procedures that lasted 30 to 45 minutes. No patient required postoperative opioids or antiemetics, although a local anesthetic had to be used at the moment of incision for 1 patient. All 3 patients were discharged the same day. We wish to underline the utility of the brachial plexus block for parathyroid surgery. The technique is easy to perform, safe, and effective; as a result, surgery can be carried out on an outpatient basis.

Topics: Adenoma; Aged; Amides; Anesthetics, Local; Autonomic Nerve Block; Brachial Plexus; Conscious Sedation; Female; Humans; Hyperparathyroidism, Primary; Hypnotics and Sedatives; Midazolam; Middle Aged; Minimally Invasive Surgical Procedures; Parathyroid Neoplasms; Parathyroidectomy; Piperidines; Remifentanil; Ropivacaine