A Retrospective Study Optimizing Anesthetic Management of Parathyroidectomy for Dialysis Patient with Secondary Hyperparathyroidism

BACKGROUND: Secondary hyperparathyroidism (SHPT) is a common complication of end-stage renal disease (ESRD). Although parathyroidectomy (PTx) has been proven a practical treatment for late and severe SHPT, patients often lose the operative chance due to multisystem dysfunction. The aim of this study was to improve perioperative anesthetic management in individualized dialysis patients for a better outcome and shorter hospital stays. METHODS: We retrospectively review 122 patients with SHPT. They were grouped by different anesthesia management, general anesthesia (GA) and monitored anesthesia care (MAC). RESULTS: Between MAC and GA groups, patients had similar demographic profile. However, patients with higher intact parathyroid hormone (iPTH) tended to recieve GA due to a possibly more extensive surgical exploration. Local anesthesia was more feasible for patients with elevated levels of creatinine. 88.6% patients underwent PTx under GA (18.9% laryngeal mask airway [LMA] and 69.7% endotracheal tube [ET]). In MAC group, 50% patients required antihypertensive drugs. In GA group, less than 1% patients need antihypertensive medications, while 39.82% required vasopressor. Most surgeries provided satisfactory curative effects with improved calcium-phosphate homeostasis, optimal PTH reduction, resolved bone pain and stable hemoglobin. Although the difference of anesthesia time between two anesthetic methods wasn’t significant, hospital stays were shorter in MAC group. CONCLUSION: Our study testified the efficiency, feasibility and safety of PTx for dialysis patients both under general and local anesthesia.