Cirugía Española

Cirugía Española

Volume 80, Issue 4, October 2006, Pages 206-213
Cirugía Española

Originales
Tiroidectomía en régimen de cirugía mayor ambulatoria. Estudio prospectivoThyroidectomy in the ambulatory setting. a prospective study

https://doi.org/10.1016/S0009-739X(06)70959-9Get rights and content

Resumen

Introducción

La reciente reintroducción de la anesthesia locorregional para la tiroidectomía ha facilitado esta cirugía en régimen de cirugía mayor ambulatoria (CMA). El objeto de este estudio fue evaluar los resultados de este tratamiento comparando 2 regímenes anestésicos.

Pacientes y métodos

Se seleccionó a 125 pacientes que precisaban tiroidectomía y cumplían requisitos de CMA. A los pacientes se les ofreció anestesia locorregional más sedación (ALS); si no aceptaron, se les propuso un método de anestesia locorregional combinada con intubación orotraqueal (ALC). Cincuenta y ocho pacientes aceptaron ALS y 67 ALC. Ambos grupos fueron comparables en edad, sexo, riesgo anestésico, índice de masa corporal y función tiroidea. Se evaluaron los vómitos postoperatorios, el dolor al alta, la necesidad de ingreso, la morbilidad postoperatoria y los problemas surgidos en el domicilio.

Resultados

Se realizaron 61 tiroidectomías bilaterales y 64 unilaterales, sin diferencia entre grupos. Tampoco hubo diferencias respecto al tiempo quirúrgico, la conversión a anestesia general, las incidencias operatorias, el diagnóstico anatomopatológico, el tamaño y el peso de las piezas de exéresis. La única diferencia entre grupos fue la hora del alta (ALS: 6,5 ± 1,2 h; ALC: 7,76 ± 2,07 h, p = 0,0003). Aunque la tasa de ingreso fue superior en ALC (22,4%), no alcanzó diferencia estadísticamente significativa respecto a ALS (8,62%) (p = 0,06), cuya causa principal era la preferencia del paciente en el grupo ALC. No hubo diferencias respecto a vómitos (7,2%) o náuseas (6,4%), dolor (2,47 ± 1,85 en escala visual analógica), o necesidad de analgésicos. A las 36 h del alta se observó un hematoma asintomático no compresivo en el grupo ALS, que ingresó en observación y no requirió cirugía. Los problemas en domicilio fueron todos menores. El grado de satisfacción fue muy alto o alto en el 95% de los casos, sin diferencias entre grupos.

Conclusiones

En casos seleccionados la tiroidectomía en régimen de CMA es segura y satisfactoria para los pacientes. Ambos regímenes anestésicos se mostraron válidos, pero la ALS mostró una recuperación más rápida que la ALC.

Introduction

The recent reintroduction of local/regional anesthesia (LRA) for thyroidectomy has enabled this intervention to be performed in the outpatient setting. The aim of this study was to compare the results of thyroidectomy using two anesthesia methods.

Patients and methods

One hundred twenty-five patients requiring thyroidectomy and who met the criteria for outpatient surgery were prospectively selected. The patients were offered LRA plus sedation; patients who did not accept this option were offered LRA combined with orotracheal intubation (CLRA). LRA was accepted by 58 patients and CLRA by 67. Age, sex, anesthesia risk, body mass index, and thyroid function were similar in both groups. Postoperative vomiting, pain at discharge, need for admission, postoperative morbidity, and complaints occurring at home were evaluated.

Results

Sixty-one bilateral and 64 unilateral thyroidectomies were performed, with no statistically significant difference between the two groups. There were no differences in surgical time, conversion to general anesthesia, intraoperative events, pathological diagnosis, or size and weight of the surgical specimen. The only difference between the two groups was the hour of discharge (LRA: 6.5 ± 1.2 hours; CLRA: 7.76 ± 2.07 hours; p = 0.0003). The admission rate was higher in the CLRA group (22.4%) than in the LRA group (8.62%); this difference was not statistically significant (p = 0.06) and the main cause was personal preference in patients in the CLRA group. Rates of postoperative morbidity, vomiting (7.2%) and nausea (6.4%), postoperative pain (2.47 ± 1.85 on a visual analog scale), and analgesic requirements showed no differences between the two groups. One patient in the LRA group developed a noncompressive asymptomatic neck hematoma 36 hours after discharge. The patient was admitted for observation but did not require reoperation. Complaints occurring at home were minor. Satisfaction with the procedure was high or very high in 95% of the patients, with no differences between the two groups.

Conclusions

In selected patients, outpatient thyroidectomy is safe and produces good patient satisfaction. Both anesthesia methods were valid, but postoperative recovery was faster with LRA than with CLRA.

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