Costly General anesthesia for Thyroid Nodule RFA Ablation. Now add another expense with continuous intraoperative neuromonitoring CIONM.
AM J. Surg C.Sinclair et al Nov 2020
Dr Guttler’s comments:
- To justify the use of a general with the risks of nerve damage while the patient is sleeping and can’t tell you about their voice, the surgeons now add CIONM during the general anesthesia. Hospital based treatment under a general is the most expensive way to treat with RFA for thyroid nodules. Outpatient in endocrine offices the fee is $5000-7000. Hospital general anesthesia treatment is $15-25,000.
- I can monitor the voice on my patients because they are awake.We ask them how is the voice during the procedure. Is the expense worth going in the hospital and getting drugged and because now with CIONM you are safe from nerve damage? I don’t think so.
- 20 nodules were studied with general and CIOM in the study.
- It was not amazing that no patient had nerve damage.
- This is an expensive way to treat patients when an outpatient procedure done in endocrinologist’s office can get the same excellent results without the fancy nerve machine and while the patient is awake by simply asked about the voice during the procedure.
- In the rare occasion there is a voice change we use the ice cold dextrose injection to the area of the nerve. If rapid recovery we can continue with the procedure, but if it persists the procedure is aborted. I have no cases of temporary or permanent nerve damage in my series.
- Why treat a thyroid nodule with a hammer instead of a feather.
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