The importance of being awake during the procedure is to be able to tell the operator that there is a problem.
Recent paper by a group of surgeons and endocrinologists had his quote.
“Patients also had additional mild conscious sedation with midazolam and/or fentanyl, and one patient required ketamine, administered by an anesthesiologist who monitored the patients’ hemodynamics throughout the procedure.”
Office based thyroid RFA done by our group of endocrinologists that excludes radiologists and surgeons does not use fentanyl or midazolam, and never uses ketamine administered by a anesthesiologist. We screen the patients for co-morbidity and refuse to put anyone to sleep. We monitor the voice throughout the procedure and have standby iced dextrose to inject around the nerve to aid fast recovery. All possible problems are handled because they are awake and can tell us if they are having pain. We can correct any of the possible the problems ASAP.
One patient developed hoarseness of voice during the procedure and 10 mL of cold D5W was injected in the tracheoesophageal groove with partial improvement in symptoms at the time.
Her voice returned to normal in 6 months. Vocal cord recovery was documented by laryngoscopy and ultrasonography.
The total complication rate was 4.2%.
Was the recurrent nerve injury while the patient was under sedation?
Reference:
Safety and Efficacy of Radiofrequency Ablation of Thyroid Nodules – Expanding Treatment Options in the United States
Iram Hussain, M.D, Fizza Zulfiqar, M.B.B.S, Xilong Li, Ph.D, Shahzad Ahmad, M.D, Jules Aljammal, M.D
Journal of the Endocrine Society, bvab110, https://doi.org/10.1210/jendso/bvab110
Call me at 1-310 393-8860 or thyroid.manager@thyroid.com for evaluation for your thyroid nodule problem and be awake during the procedure. Ask for Alicia.
5 Comments
Mild conscious sedation means that the patients were awake and talking during the procedure. They are actually asked to repeat their address and otherwise speak every 1 – 2 minutes to make sure there are no problems. (Moderate sedation is when patients are put to sleep and would defeat the purpose of RFA).
Hoarseness of voice in one patient developed during the procedure and was picked up immediately and treated with cold dextrose. Partial improvement was also immediate.
No radiologists or surgeons were involved in this study.
Regards,
Iram Hussain, MD
(Endocrinologist)
Iram,
Noted,
Thanks
Richard
Dr.Hussain,
Recent international meetings on RFA did not mention sedation, only local.
Good luck with your approach.
Dr.G.
Dr.Hussain
Why use any sedation when local is the method of choice?
DR.G.
Sedation was used for the first several cases when treating physicians were starting out and were wary of causing discomfort.
Now just local is used as you suggest with good results. However, longer follow-up and larger patient sample will be needed before that data can be published.
Agree that doing this under local anesthesia is ideal.
The procedure is operator dependent and as physicians get more practiced I expect it will become more common to consider this a first line office procedure for symptomatic thyroid nodules.
Best wishes!
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