Remimazolam Anesthesia With Intratracheal Topical Anesthesia and Cervical and Glossopharyngeal Nerve Blocks for Thyroid Lobectomy: A Case Report

In thyroid surgery, anesthetic management is required to maintain the reliability of intraoperative neuromonitoring (IONM) while facilitating early postoperative assessment of vocal function, suppressing coughing during extubation, and providing adequate postoperative analgesia.In a 63-year-old man undergoing right thyroid lobectomy with IONM, general anesthesia with remimazolam was combined with intratracheal topical anesthesia, bilateral superficial cervical plexus blocks, and bilateral glossopharyngeal nerve blocks.After induction of anesthesia, intratracheal topical anesthesia was performed using 4 mL of 4% lidocaine.A total of 10 mL of 0.25% levobupivacaine was used for the bilateral superficial cervical plexus blocks, and a total of 5 mL of 0.25% levobupivacaine was used for the bilateral glossopharyngeal nerve blocks.Four minutes after the start of surgery, sugammadex was administered to reverse neuromuscular blockade.Electromyographic responses were confirmed after sugammadex administration, and no loss of signal occurred during surgery.At the end of surgery, 0.5 mg of flumazenil was administered, resulting in rapid and clear emergence from anesthesia.No coughing was observed before or after extubation.After extubation, the patient was able to phonate clearly, with no apparent hoarseness, and postoperative pain was well controlled.General anesthesia with remimazolam combined with intratracheal topical anesthesia and head and neck nerve blocks may be an anesthetic option for thyroid surgery with IONM to facilitate early postoperative assessment of vocal function, suppress coughing during extubation, and provide adequate postoperative analgesia.