Michael Chang1, Alanna Coughran2, Yu-Jin Lee3, Jeremy Collins4, Davud Sirjani5. 1. Department of Otolaryngology-Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA, USA 94305. Electronic address: Michael.t.chang@stanford.edu. 2. Department of Otolaryngology-Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA, USA 94305. Electronic address: alannac@stanford.edu. 3. Department of Otolaryngology-Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA, USA 94305; Department of Health Research and Policy, Stanford University, Stanford, CA 94305, USA. Electronic address: yujinlee@stanford.edu. 4. Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA 94305, USA. Electronic address: jcoll@stanford.edu. 5. Department of Otolaryngology-Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA, USA 94305. Electronic address: dsirjani@stanford.edu.
Abstract
OBJECTIVE: To report the patient selection, surgical technique, and outcomes of parotidectomy using local anesthesia under monitored anesthesia care (MAC). METHODS: A retrospective chart review was performed for patients undergoing parotidectomy under local anesthesia at an academic head and neck surgery center. RESULTS: Six patients deemed high risk for general anesthesia (GA) due to medical comorbidities or with a strong preference to avoid GA underwent parotidectomy using local anesthesia and MAC. Parotidectomy was performed for several indications, including benign tumors, malignant tumors, and chronic sialadenitis. Mean age of patients was 78.0 ± 7.9 years, and all had an American Society of Anesthesia score ≥ 2 and Charlson comorbidity index ≥4. Mean operative time was 102.8 ± 38.3 min, comparable to that of parotidectomy under general anesthesia. No major complications occurred. Minor complications included three cases of temporary postoperative facial nerve weakness limited to 1-2 lower division branches. At most recent follow up (10 to 48 months), all patients were medically stable and disease free. CONCLUSION: In carefully selected patients, parotidectomy under local anesthesia is a viable treatment alternative that can be offered to patients. Successful outcomes require preoperative counseling, meticulous technique, and close collaboration with anesthesia colleagues.
OBJECTIVE: To report the patient selection, surgical technique, and outcomes of parotidectomy using local anesthesia under monitored anesthesia care (MAC). METHODS: A retrospective chart review was performed for patients undergoing parotidectomy under local anesthesia at an academic head and neck surgery center. RESULTS: Six patients deemed high risk for general anesthesia (GA) due to medical comorbidities or with a strong preference to avoid GA underwent parotidectomy using local anesthesia and MAC. Parotidectomy was performed for several indications, including benign tumors, malignant tumors, and chronic sialadenitis. Mean age of patients was 78.0 ± 7.9 years, and all had an American Society of Anesthesia score ≥ 2 and Charlson comorbidity index ≥4. Mean operative time was 102.8 ± 38.3 min, comparable to that of parotidectomy under general anesthesia. No major complications occurred. Minor complications included three cases of temporary postoperative facial nerve weakness limited to 1-2 lower division branches. At most recent follow up (10 to 48 months), all patients were medically stable and disease free. CONCLUSION: In carefully selected patients, parotidectomy under local anesthesia is a viable treatment alternative that can be offered to patients. Successful outcomes require preoperative counseling, meticulous technique, and close collaboration with anesthesia colleagues.
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