Awake thyroidectomy
Thorsen W. Haugen MD  Luke N. Andera MD  Archie B. LaMadrid MD
First published: 30 July 2019 https://doi.org/10.1002/lary.28196
Editor's Note: This Manuscript was accepted for publication on July 5, 2019.
The authors have no funding, financial relationships, or conflicts of interest to disclose.
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Abstract
Objective
In this article, we present a series of 28 patients who underwent thyroid surgery using local anesthesia. We describe our technique, report outcomes, and assess how well the procedure was tolerated from a patient perspective.

Methods
Three surgeons performed awake thyroidectomies and recorded data, including the patient's age and gender, surgery being performed, operative time, weight of the surgical specimen, quantity and type of local anesthetic used, additional medications, patient‐reported pain assessment, and any complications.

Results
Twenty‐seven of 28 patients (96%) successfully underwent awake thyroidectomy. One patient had to be converted to general anesthesia due to airway concerns. There were no complications; however, one patient had a panic attack. Based on a 0 to 10 scaled pain score, the average amount of pain reported was 3.4. The amount of pain the patient reported was significantly dependent on the amount of experience the operating surgeon had with this technique. Seventy‐one percent of patients tolerated surgery with local anesthesia only and did not require additional medications.

Conclusion
Awake thyroidectomy is a well‐tolerated and safe procedure in appropriately selected patients, with many potential benefits over general anesthesia. In most cases, only local anesthesia is required. Increased experience with this technique may be associated with increased patient comfort.

Level of Evidence
4 Laryngoscope, 2019