Dear Dr. Boone, I reached out to you earlier this year when I suspected I had parathyroid disease. I have just recently been definitely diagnosed. I am presently researching and planning to have the surgery in the near future. The doctor here in Chicago with whom I consulted uses General anesthesia but I have read that others use a "light" anesthesia (with no intubation required). What type of anesthesia do you typically use when you perform your surgeries? Thank you!
Thanks for asking. Most surgeons use general anesthesia for parathyroid surgery. I use general anesthesia for all patients, and this is what I did when I was at the Norman Parathyroid Center as well.
The terms regarding anesthesia can be confusing. “Light anesthesia” is not really a term that physicians use. The major categories of anesthesia are as follows:
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General Anesthesia: This means you are “asleep” for the operation - you are unaware of what is happening. It’s administered either through inhalation or intravenous (IV) drugs. Under general anesthesia, patients feel no pain and have no memory of the procedure. You can give general anesthesia with an endotracheal tube (intubation with a tube placed in the trachea to protect your airway) or with a Laryngeal Mask Airway (LMA, a tube and cuff placed down the throat to the entry to the trachea). The LMA can cause less throat soreness, but is not as safe for operations on the neck, since it can become dislodged and does not seal the airway from secretions. There is a parathyroid center that refers to general anesthesia with an LMA as “light anesthesia” but this is inaccurate - it is full general anesthesia.
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Regional Anesthesia: This type numbs a larger part of the body, such as a limb or the lower half of the body. It’s commonly used for procedures on specific regions of the body. You can still be awake and alert with regional anesthesia. This can be done for parathyroid operations, but is very uncommon, as it is a highly specialized procedure (with its own risks) and most patients do not want to be awake for the operation.
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Local Anesthesia: This type numbs a small, specific area of the body. It’s often used for minor procedures, such as dental work or skin biopsies. I use local anesthesia at the skin incision site for parathyroid surgery, to help with postoperative pain at the skin site. Using just local anesthesia for a parathyroid operation would be possible in very limited circumstances. It would not be possible to look at all four parathyroid glands with just local anesthesia, and typically you would still need some sedation to get through the operation.
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Sedation (Monitored Anesthesia Care): This involves the administration of drugs that induce a state of relaxation and drowsiness. It is often used in combination with regional or local anesthesia, to make the patient comfortable during the operation.
The optimal anesthesia depends on the operation and the individual patient. For parathyroid surgery, in which you are operating deep in the neck, general anesthesia with intubation is the safest and best option for almost all patients.
