A Sonosite SII point-of-care ultrasound system recently played a key role in an innovative procedure of thyroid surgery without the use of general anesthetic.
Dr. Rüdiger Eichholz, a consultant anesthetist working for private practice in Stuttgart, Germany, explained the case.
“We were approached with an unusual case; a young woman in need of thyroid surgery, but unwilling to have a general anesthetic due to a childhood medical trauma,” said Dr. Eicholz. “We looked at the possibility of performing an ultrasound-guided block of the cervical nerves pathway – a technique commonly used for carotid endarterectomies – but there are a number of additional concerns using this nerve block bilaterally for thyroid surgery. The primary consideration was to use the smallest volume of anesthetic possible that would still cover as much of the surgical site as possible. Increasing the local anesthetic dose can lead to high risk complications with acute shortness of breath, due to unintended blocks of the recurrent laryngeal nerves, or diaphragmatic paresis secondary to phrenic nerve blocks.”
“Too much anesthesia can also lead to swallowing difficulties or blockade of the cervical sympathetic trunk. Point-of-care ultrasound needle guidance was an obvious solution to help us overcome these issues, as it would allow precise delivery of smaller doses to avoid anesthetic ‘spread’, and very good image quality was essential, due to the proximity of the various anatomical structures in the neck,” Dr. Eicholz explained.
“The Sonosite SII was ideal for this application, combining excellent image quality with an intuitive touchscreen interface that makes it easy to optimise image settings. This made it very easy to visualize the needle and nerve structures.”
“This particular patient did not want any other form of pain relief for the small areas of the surgical site that were not expected to be covered by the cervical plexus block. In the meantime, we have successfully followed this approach for other cases, combining the nerve block with a short-acting analgesic. This method of pain control allows patients to be fully alert during or immediately after surgery, without any pain, offering much faster recovery times and providing an alternative to general anesthesia for thyroid and parathyroid surgery. All patients who have undergone this procedure have scored high on the patient comfort scale.”
“This successful new approach was achieved through the excellent cooperation of the anesthesia team and the surgical team of Professor Dr. Andreas Zielke and his consultant Dr. Constantin A. Smaxwil from the Department for Endocrine Surgery at the Diakonie-Klinikum Stuttgart.”
“The outstanding technology of the Sonosite SII system helped us implement our plan.”
Sonosite Point-of-Care Ultrasound and Anesthesia
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