Thyroid Surgery When General Anesthesia is Not Feasible Manilal Aich 1 , Md. Asadur Rahman 2 , Sharfuddin Mahmud 3 , Siddikur Rahman 4 , Md. Mizanur Rahman 5 , DGM Akaiduzzaman 6 , Md. Zahedul Alam 7 Abstract Historically, thyroid and parathyroid surgery was done initially under local anesthesia. With the advent of safer general anesthetic techniques, the need for local anesthesia fell dramatically. Recently the use of local anesthesia combined with monitored anesthesia care (MAC) has been reintroduced as an alternative to general anesthesia for some particular thyroidectomy. Newer intravenous anesthetic agents allow for the establishment of effective sedation and analgesia with adjusted level and duration of action. This allows for monitoring of the effectiveness of the anesthesia during the surgical procedure that meet the patient’s comfortable needs and the surgeon’s technical needs. This approach allows for rapid recovery of alertness and early assessment of the patient’s initial postoperative recovery. Additionally, it optimizes the potential for outpatient surgical care. We report a 25 year old male, diagnosed as a case of follicular adenoma of thyroid with emphysematous bullae; who had undergone thyroidectomy under local anaesthesia. Surgery was uneventful and resulted in a decreased length of stay, cost and operating time. Key words: Local anaesthesia, thyroid surgery, general anaesthesia. Case Report Bangladesh J Otorhinolaryngol 2014; 20(2): 93-97 1. Professor, Dept. of Otolaryngology and Head- Neck Surgery, Sir Salimullah Medical College & Mitford Hospital, Dhaka. 2. Registrar, Dept. of Otolaryngology and Head- Neck Surgery, Sir Salimullah Medical College & Mitford Hospital, Dhaka. 3. Assistant Registrar, Dept. of Otolaryngology and Head- Neck Surgery, Sir Salimullah Medical College & Mitford Hospital, Dhaka. 4. Assistant Registrar, Dept. of Otolaryngology and Head- Neck Surgery, Sir Salimullah Medical College & Mitford Hospital, Dhaka 5. Registrar, Dept. of Otolaryngology and Head- Neck Surgery, Sir Salimullah Medical College & Mitford Hospital, Dhaka. 6. Assistant Professor Dept. of Otolaryngology and Head- Neck Surgery, Sir Salimullah Medical College & Mitford Hospital, Dhaka 7. Professor, Dept. of Otolaryngology and Head- Neck Surgery, Sir Salimullah Medical College & Mitford Hospital, Dhaka. Address of correspondence: Dr. Sharfuddin Mahmud, Assistant Registrar, Dept. of Otolaryngology and Head- Neck Surgery, Sir Salimullah Medical College & Mitford Hospital, Dhaka, Contact: 01817544133; E-mail: mahmudssmc@yahoo.com. Introduction Thyroid surgery is most commonly performed under general anaesthesia now-a-days 1 . Historically, surgery in patients with thyroid disease especially thyrotoxicosis was performed using local anaesthesia 2 . As medical therapy evolved to provide reliable means of maintaining euthyroid state and as general anaesthesia became safer, many procedures including thyroid surgery are being done exclusively under general anaesthesia. However, over the last three decades, there has been resurgence in numbers of thyroid operations under local anaestheisa. All known thyroid surgeries under local anaesthesia were done for multinodular goiter. Local anaesthesia can provide good analgesia and avoid major side effects of general anaesthesia 3 . In addition, the analgesia continues in the post operative period, thus modifying the autonomic and endocrine stress of surgery leading to rapid recovery 3 . In this case report a malignant thyroid case is