title: Total thyroidectomy for giant goiter under local anesthesia and Ketamine in a surgical mission.
abstract: BACKGROUND
  Operation Giving Back (OGB) of the American College of Surgeons (ACS) and various other surgical missions in the developing world have become more popular and provide a valuable way of reducing the surgical burden worldwide. While most cases are "bread and butter" general surgery, difficult surgeries are often encountered.
  
  
  METHODS
  Description of a total thyroidectomy for super giant goiter extending to chest inferiorly, lateral neck and behind both ears, compressing the trachea and causing chronic difficulties breathing. The surgical team was unable to intubate, but performed surgery under local anesthesia and sedation with Ketamine injection.
  
  
  RESULTS
  Total thyroidectomy, as a life-saving procedure, was performed under local anesthesia and Ketamine with mild sedation. Once thyroid was removed, the outside diameter of trachea was assessed to be 4mm. Patient tolerated the procedure well and had no postoperative complication. Her breathing improved significantly post-operatively. Five years later, she is doing well.
  
  
  CONCLUSIONS
  Total thyroidectomy for giant goiters can be done under local anesthesia with Ketamine and proper sedation. Surgeons and anesthesiologists participating in surgical missions may have to perform major surgery under local anesthesia.
authors.affiliation: Department of Surgery, University of Arizona, Tucson, AZ, USA. Electronic address: Rlatifi@email.arizona.edu.
authors.forename: Rifat
authors.initials: R
authors.lastname: Latifi
authors.affiliation: Chandler Anesthesia Consultants, Gilbert, AZ, USA.
authors.forename: Joan
authors.initials: J
authors.lastname: Harper
authors.affiliation: HSHS Medical Group, Breese, IL, USA.
authors.forename: Renato
authors.initials: R
authors.lastname: Rivera
keywords: Difficult airway; Ketamine; Surgical mission; Total thyroidectomy; Unable to intubate