Elective Thyroidectomy Research Articles

8113 Thyroid Storm in a Patient with Thyroid Nodule on Anticoagulation

Abstract Disclosure: R. Kulkarni: None. S.S. Krishnasamy: None. N. Mon: None. R. Downs: None. Background: There are very few case reports related to hyperthyroidism due to anticoagulation use. We describe a case, of a less common cause of hyperthyroidism due to hemorrhagic thyroiditis in a patient on anticoagulation and history of metastatic colon cancer. Clinical case: A 67-year-old white male with PMH significant for colon cancer with liver metastasis s/p exploratory laparotomy with sigmoid colectomy, end-colostomy with Hartman's pouch creation, pre-diabetes, recent left IJ & axillary vein thrombus on Eliquis, and thyroid nodule; presented with complaints of shortness of breath, difficulty swallowing and dizziness. Other symptoms included weight loss, complaints of heart racing and generalized body aches. The patient had a recent admission for similar complaints and was newly diagnosed with left IJ/axillary vein thrombus and expanding hemorrhagic thyroid nodule on imaging. He was discharged on anticoagulation for the DVT with 2 week follow up for elective thyroidectomy for goiter. The patient was admitted to the ICU for worsened respiratory status needing ventilatory support and pressor support. Physical findings on admission included jaundice, sinus tachycardia, lethargy with agitation. Initial labs showed TSH 0.02 uIU/mL, FT4 4.85 ng/dL and FT3 6.8 pg/mL, LFTs >500 U/L. Burch-Wartofsky Point Scale score was >60 suggestive of thyroid storm. Imaging with PET CT was concerning for thyroid enlargement with multiple nodules with increased uptake. Thyroid US was consistent with heterogenous gland with hemorrhagic nodules. Based on clinical history, physical findings, diagnostic labs, and imaging the patient was diagnosed with severe hyperthyroidism with thyroid storm secondary to hemorrhagic thyroid nodules in the setting of anticoagulation. The patient underwent thyroid artery angiogram with particle embolization of left inferior and right superior thyroid arteries. Endocrinology started the patient on methylprednisolone, cholestyramine and propranolol. Thionamide was held since the patient had abnormal liver function tests in the setting of shock liver. The patient’s thyroid function slowly improved on current regimen to TSH 0.05 uIU/mL, FT4 1.7 ng/Dl and FT3 4.1 pg/mL on day 3. At the family interdisciplinary meeting, due to guarded prognosis, family opted for comfort care, and the patient finally succumbed to multiple co-morbidities. Conclusion: The case presented discusses diagnosis and management of less common causes of hyperthyroidism and management of thyroid storm in liver dysfunction. The patient would have needed a thyroid biopsy at a later date to rule out colonic metastasis as a cause of hemorrhage if he had survived the thyroid storm and comorbid illnesses. Presentation: 6/3/2024

Effects of preoperative inhaled budesonide combined with intravenous dexamethasone on postoperative sore throat in patients who underwent thyroidectomy: A randomized controlled trial.

This randomized controlled trial aimed to evaluate the efficacy of preoperative inhaled budesonide combined with intravenous dexamethasone on postoperative sore throat (POST) after general anesthesia in patients who underwent thyroidectomy. Patients who underwent elective thyroidectomy were randomly divided into the intravenous dexamethasone group (group A) and budesonide inhalation combined with intravenous dexamethasone group (group B). All patients underwent general anesthesia. The incidence and severity of POST, hoarseness, and cough at 1, 6, 12, and 24 hours after surgery were evaluated and compared between the 2 groups. There were 48 and 49 patients in groups A and B, respectively. The incidence of POST was significantly lower at 6, 12, and 24 hours in group B than that in group A (P < .05). In addition, group B had a significantly lower incidence of coughing at 24 hours (P = .047). Compared with group A, the severity of POST was significantly lower at 6 (P = .027), 12 (P = .004), and 24 (P = .005) hours at rest, and at 6 (P = .002), 12 (P = .038), and 24 (P = .015) hours during swallowing in group B. The incidence and severity of hoarseness were comparable at each time-point between the 2 groups (P > .05). Preoperative inhaled budesonide combined with intravenous dexamethasone reduced the incidence and severity of POST at 6, 12, and 24 hours after extubation compared with intravenous dexamethasone alone in patients who underwent thyroidectomy. Additionally, this combination decreased the incidence of postoperative coughing at 24 hours.

Sepsis and Septic Shock in Patients Undergoing Thyroidectomy: Incidence, Risk Factors, and Outcomes

IntroductionPostoperative sepsis represents a rare complication following thyroidectomy. We aimed to explore the incidence, risk factors, sources, and outcomes of postoperative sepsis and septic shock among adult patients undergoing thyroidectomy. MethodsData from the American College of Surgeons National Surgical Quality Improvement Program were used in this retrospective cohort study. Patients aged ≥18 y who underwent elective thyroidectomy between 2005 and 2019 were included. Multivariable binary logistic regression models were computed to explore risk factors and outcomes of 30-d sepsis and septic shock. ResultsAmong the 180,373 included patients, 0.1% developed sepsis or septic shock. Male gender, low body mass index, American Society of Anesthesiologists classes 3-5, functional dependence, smoking, diabetes mellitus, pulmonary disease, inpatient surgery, malignant indication, clean-contaminated wound classification, and operation time ≥150 min were significant risk factors for development of sepsis or septic shock. Common infectious sources of sepsis included surgical site infections (29.6%), pneumonia (18.6%), urinary tract infections (16.2%), and multiple infections (6.9%). Patients with postoperative sepsis or septic shock were significantly more likely to develop complications, including wound disruption, stroke, cardiac and renal complications, thromboembolism, prolonged length of stay, unplanned reoperation, and mortality. ConclusionsSepsis is rare following thyroidectomy. Our study provides insight into risk factors and procedural characteristics which may contribute to the development of postoperative sepsis or septic shock in this population.

Impact of Drain Placement on Postoperative Complications after Thyroidectomy for Substernal Goiter.

Introduction Despite the evidence against drain placement after thyroidectomy, there is a lack of consensus on drain use in patients with substernal goiter. Objective To assess the factors that increase the likelihood of drain placement and its impact on postoperative hematoma and other 30-day complications among adult patients undergoing thyroidectomy for substernal goiter. Methods A retrospective cohort study that used data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Adult patients (aged ≥ 18 years) who underwent elective thyroidectomy for substernal goiter from 2016 to 2020 were included. Cases with closed suction neck drains placed upon completion of surgery were included in the drain group, and the remaining cases formed the nondrain group. Results A total of 1,229 patients were included (46.5% with drain placement). The factors that increased the likelihood of drain placement included body mass index (BMI) ≥ 30 kg/m 2 , score between 3 and 5 on the American Society of Anesthesiologists (ASA) physical status classification, sternal split/transthoracic surgical approach, operative time ≥ 90 minutes, and surgery conducted by otolaryngologists. Patients with clean-contaminated or contaminated wound classifications were less likely to be submitted to drain placement. In addition, drain use had no impact on postoperative hematoma formation but was found to independently increase the risk of prolonged length of hospital stay. Conclusion Thyroidectomy without drain placement might be safe for substernal goiter. However, this decision should be individualized for each patient. Level Of Evidence: 3.

Comparison of Bilateral Ultrasound-Guided Intermediate Cervical Plexus Block vs Local Wound Infiltration for Postoperative Analgesia in Patients Undergoing Total Thyroidectomy

Abstract Background The thyroid gland surgery is a common and painful procedure demanding analgesia. Bilateral intermediate cervical plexus block (BSCPB) could be beneficial for analgesia in thyroid surgery. In this study we will evaluate the analgesic efficacy of ultrasound guided intermediate cervical plexus block vs local wound infiltration in patients undergoing elective thyroidectomy under general anaesthesia. Objective To evaluate the analgesic efficacy and possible side effects of ultrasound guided intermediate cervical plexus block vs local wound infiltration in patients undergoing elective thyroidectomy under general anaesthesia as a primary outcome. The secondary outcome is the assessment of the safety of ICPB and the total dose of meperidine used for 24 hours postoperatively. Patients and Methods 40 patients were divided into two equal groups: Group A: The patients received intermediate cervical plexus block with 10 ml of 0.25% bupivacaine. The same will be repeated on the contralateral side. Group B: Patient will receive local wound infiltration with 20 ml bupivacaine 0.25% under the skin immediately before extubation by the surgeon for pain control. Results ICPB group showed significant lower median score compared with LWI group at time 2 hrs, 4 hrs, 6 hrs, 12 hrs The time for first dose meperidine was significantly longer in ICPB group (17.2 ± 3.02 vs 10.15 ± 1.84) while Total 24 h meperidine consumption was significantly less in ICPB (26.25 ± 17.16 vs 36.25 ± 12.76) Conclusion Intermediate cervical plexus block provides another safe alternative analgesia compared to superficial blocks and local wound infiltration with better analgesic efficacy.

Effects of Different Doses of Esketamine on Pain Sensitivity of Patients Undergoing Thyroidectomy: A Randomized Controlled Trial.

Several factors may lead to increased postoperative pain sensitivity, of which remifentanil-induced hyperalgesia (RIH) is one of the main factors. High-dose remifentanil exposure during anesthesia may induce RIH. Esketamine may prevent RIH by antagonizing N-methyl-D-aspartate (NMDA) receptors, thereby reducing the postoperative pain sensitivity. This study examined the effects of different esketamine doses on pain sensitivity in patients undergoing thyroidectomy and determined the optimal dose. This study included 117 patients who received elective thyroidectomy. They were randomized into four groups: saline group (group C), esketamine 0.2mg·kg-1 group (group RK1), esketamine 0.4mg·kg-1 group (group RK2), and esketamine 0.6mg·kg-1 group (group RK3). Five minutes before anesthesia induction, the same volume of study drugs were injected respectively in groups C, RK1, RK2, and RK3. Remifentanil was pumped at the same rate of 0.3µg·kg-1·min-1 during surgery to ensure uniformity. This study's primary outcomes were the mechanical pain thresholds measured before surgery, as well as at 30min, 6h, 24h, and 48h after surgery. Hyperalgesia, rescue analgesia, numerical rating scale (NRS) score, and adverse reactions were recorded. Compared with baseline, the mechanical pain threshold was significantly decreased in group C [(94.67 ± 22.85) versus (112.00 ± 36.62) versus (161.33 ± 53.28) g, P < 0.001 at 30min, P < 0.001 at 6h] and group RK1 [(102.86 ± 24.17) versus (114.29 ± 41.05) versus (160.00 ± 54.98) g, P < 0.001 at 30min, P < 0.001 at 6h] around the surgical incision, and in group C [(112.00 ± 31.78) versus (170.67 ± 56.26) g, P < 0.001 at 30min, (118.67 ± 34.42) versus (170.67 ± 56.26) g, P = 0.001 at 6h] and group RK1 [(114.29 ± 45.17) versus (175.71 ± 54.80) g, P = 0.001 at 30min, (121.43 ± 38.46) versus (175.71 ± 54.80) g, P = 0.002 at 6h] on the forearm at 30min and 6h after surgery; compared with group C, the mechanical pain threshold was higher in group RK2 [(142.76 ± 50.06) versus (94.67 ± 22.85) g, P < 0.001 at 30min, (145.52 ± 49.83) versus (112.00 ± 36.62) g, P < 0.001 at 6h] and group RK3 [(140.00 ± 40.68) versus (94.67 ± 22.85) g, P < 0.001 at 30min, (150.67 ± 56.50) versus (112.00 ± 36.62) g, P = 0.010 at 6h] around the surgical incision, and in group RK2 [(149.66 ± 39.50) versus (112.00 ± 31.78) g, P = 0.006 at 30min, (156.55 ± 47.23) versus (118.67 ± 34.42) g, P = 0.005 at 6h] and group RK3 [(145.33 ± 51.18) versus (112.00 ± 31.78) g, P = 0.018 at 30min, (154.67 ± 47.54) versus (118.67 ± 34.42) g, P = 0.008 at 6h] on the forearm at 30min and 6h after surgery. Group RK3 had more glandular secretions than the other three groups (P = 0.042). Intravenous injection of esketamine 0.4mg·kg-1 before anesthesia induction is a suitable dose to reduce pain sensitivity in patients undergoing thyroidectomy without increasing adverse reactions. However, future research needs to be extended to other populations. Registered at the Chinese Clinical Trials Registry http://www.chictr.org.cn/ (09/06/2022, ChiCTR-2200060741).

Effect of common OPRM1, COMT, SLC6A4, ABCB1, and CYP2B6 polymorphisms on perioperative analgesic and propofol demands on patients subjected to thyroidectomy surgery

BackgroundPerioperative anesthetic and/or analgesic demand present considerable variation, and part of that variation appears to be genetic in origin. Here we investigate the impact of common polymorphisms in OPRM1, COMT, SLC6A4, ABCB1, and CYP2B6 genes, on the intra-operative consumption of remifentanil and propofol, as well as the postoperative analgesic needs, in patients subjected to thyroidectomy surgery.MethodsWe conducted a prospective cohort study with 90 patients scheduled to undergo elective thyroidectomy, under total intravenous anesthesia achieved by target control infusion (TCI) of propofol and remifentanil. Postoperative analgesics were administered by protocol and on-demand by the individual patient. Genotyping was established by PCR–RFLP methods. Genotyping data, intra-operative hemodynamics, and total consumption of remifentanil and propofol, as well as postoperative analgesic needs and pain perception, were recorded for each individual.ResultsPatients with the ABCB1 3435TT genotype appeared to experience significantly less pain within one hour post-operatively, compared to C carriers [mean VAS (SD) = 0.86 (1.22) vs. 2.42 (1.75); p = 0.017], a finding limited to those seeking rescue analgesic treatment. Intra-operatively, homozygotes patients for the minor allele of OPRM1 A118G and CYP2B6 G516T appeared to consume less remifentanil [mean (SD) = 9.12 (1.01) vs. 13.53 (5.15), for OPRM1 118GG and A carriers] and propofol [median (range) = 14.95 (11.53, 1359.5) vs. 121.4 (1.43, 2349.4), for CYP2B6 516TT and G carriers, respectively] but the difference was not statistically significant in our sample.ConclusionsThe ABCB1 C3435T polymorphism appears to affect the postoperative perception of surgical pain among patients with low pain threshold. The small number of minor allele homozygotes for the OPRM1 A118G and CYP2B6 G516T polymorphisms precludes a definitive conclusion regarding the inclusion of the latter in a TCI-programming algorithm, based on the results of this study.Clinical trial registration numberACTRN12616001598471.

Functional MRI Changes in Patients after Thyroidectomy under General Anesthesia.

Cognitive changes affecting elderly patients following surgery under anesthesia have drawn significant attention and have been investigated in considerable depth. Resting-state functional magnetic resonance imaging (rs-fMRI) can be used to assess changes in brain functional connectivity (FC) associated with postoperative changes in cognition, a common complication in seniors undergoing surgery. In this study, we recruited 20 patients over 55 of age and scheduled an elective thyroidectomy under general anesthesia to assess perioperative changes in brain FC density (FCD) in patients undergoing thyroidectomy under general anesthesia using rs-fMRI. All 20 patients underwent a series of clinical, quantitative, neurological, and neuropsychological tests and fMRI examinations on the day before surgery (Day 0) and 7 days after surgery (Day 7). The following tests were conducted on all patients: the Minimental State Examination (MMSE), the digit symbol substitution test (DSST), the trail making test (part A), the verbal fluency test, and Warrington's recognition memory test (WRMT). FMRI data were acquired using a 3T MR system; the FCD values were calculated using the REST software package. We used paired t-tests to compare the FCD between Day 7 and Day 0. A value of p < 0.05 was considered to reflect statistical significance. The postoperative FCD was significantly reduced in the supplementary motor area (SMA). Analyses of the percentage changes of errors in the WRMT revealed a significant and negative correlation with the mean percentage change of FCD in the SMA (Spearman's r = −0.54, 95% CI: (-0.80, -0.12), p = 0.014). Postoperative changes in FCD in the SMA may be associated with the perioperative neurocognitive changes in patients undergoing partial thyroidectomy under general anesthesia.

Effects of Preoperative Electroacupuncture on Remifentanil-Induced Post-Infusion Hyperalgesia in Patients Undergoing Thyroidectomy: A Double-Blind Randomized Controlled Trial

ObjectiveElectroacupuncture (EA) delivered one day before surgery could reduce postoperative pain. Remifentanil-induced post-infusion hyperalgesia (RPH) was occurred after exposure to high-dose remifentanil. This study aimed to investigate the effects of preoperative EA on RPH in patients undergoing thyroidectomy.MethodsA total of 80 patients who were scheduled to undergo elective thyroidectomy were randomly assigned to two groups: an EA group and a sham EA (SEA) group. EA was delivered at the Zusanli (ST36) and Neiguan (PC6) acupoints 24 h before the surgery. To ensure uniformity across all patients, remifentanil was administered at the same set rate (0.3 μg/kg/min) to all patients. Mechanical pain thresholds were recorded by an electronic von Frey device around the skin incision and on the arm before surgery as well as at 30 min and 6, 24, and 48 h after surgery.ResultsAt 30 min and 6 h after surgery, the EA group showed considerably greater mechanical pain thresholds surrounding the surgical site compared with the SEA group. At 30 min and 6 h after surgery, the patients in the SEA group showed a greater incidence of postoperative hyperalgesia surrounding the surgical site than those in the EA group. At 24 and 48 h after surgery, no significant differences were found between the two groups, although the pain intensity of the EA group was less than that of the SEA group. There were also no substantial differences between the two groups in the frequency of postoperative adverse reactions and rescue analgesia needed.ConclusionEA administered 24 h before surgery could alleviate RPH in patients undergoing thyroidectomy.

Factors associated with thyroidectomy complications in resource-limited settings: An observational study

Background: Even though thyroidectomy outcomes and their predictive factors are various and widely studied, the data from our country and other African countries where the disease burden is high are limited. The main aim of this study was to evaluate the incidence and factors associated with thyroidectomies complication in a resource limited setting where the procedures were performed by general surgeons/general surgery residents. MethodsThis is an observational study of one hundred ninety-nine patients undergoing elective thyroidectomy from September 1, 2020, to August 30, 2021. The primary outcomes are the incidence and types of complications observed during and after surgery. The secondary outcomes are identifying risk factors associated with complications. Bivariate and multivariate logistic regressions were used to identify risk factors. P-value < 0.05 was considered statistically significant. ResultThe incidence of complications after thyroid surgeries was 18.6%. The two commonest complications were an external branch of the superior laryngeal nerve (EBSLNI) injury and hypocalcemia. Thyroidectomy performed by residents and patients who underwent total thyroidectomy, the independent risk factor of the EBSLN injury [AOR = 8.015; 95%CI (1.402–45.807); P = 0.019 and postoperative hypocalcemia [AOR = 17.797; 95%CI (3.799–83.374); P < 0.001, resulted in an incidence of 7.54% and 5.53% respectively. ConclusionThe incidence of thyroidectomy complications is relatively similar to other studies. However, the provision of special training for residents on surgical techniques to prevent EBSLN injury and performing non-total thyroidectomies for benign thyroid diseases are recommended to reduce complications.

A Comprehensive Assessment of Blood Transfusions in Elective Thyroidectomy Based on 180,483 Patients.

To assess the incidence, risk factors, and complications of blood transfusions (BTs) in elective thyroidectomy patients. A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program. Adult patients who underwent elective thyroidectomy from 2005 to 2019 were divided into two cohorts based on whether they received BT or not. Multivariable binary logistic regression models were used to identify risk factors of BT and its impact on postoperative complications. Of 180,483 patients, 0.13% received BT. Risk factors for BT included underweight body mass index (BMI) (adjusted odds ratio [OR] 3.179, 95% confidence interval [CI] 1.444-6.996), bleeding disorders (OR 2.121, 95% CI 1.149-3.913), anemia (OR 4.730, 95% CI 3.472-6.445), preoperative transfusion (OR 7.230, 95% CI 1.454-35.946), American Society of Anesthesiology physical statuses 3-5 (OR 3.103, 95% CI 2.143-4.492), operative time >150 min (OR 4.390, 95% CI 1.996-9.654), and inpatient thyroidectomy (OR 5.791, 95% CI 3.816-8.787). In addition, transfusion was independently associated with any postoperative complication, non-infectious, cardiac, pulmonary, renal, vascular, or infectious complications, surgical site infection, sepsis, septic shock, wound disruption, pneumonia, unplanned reoperation, prolonged length of stay, and mortality. Recognition of risk factors of BT is imperative to identify at-risk patients and reduce transfusions by controlling modifiable risk factors such as anemia, operative time, and BMI. In cases where transfusions are still indicated, surgeons should optimize care to prevent or adequately manage transfusion-associated complications. 3 Laryngoscope, 132:2078-2084, 2022.

Carotid Artery Blood Flow Changes Associated with Head Positioning in Patients Undergoing Thyroidectomy.

Background and Aims:There are possibilities of insufficiency in blood flow through carotid arteries during head positioning in thyroid surgeries under general anesthesia which is usually compensated by collateral circulation in normal conditions. This compensation may be hampered in patients with congenital abnormalities or diseases such as atherosclerosis. We aimed to elucidate the changes in common carotid artery blood flow related to head positioning during thyroid surgery by Doppler examination.Methods:In this observational prospective study, Doppler examination of both common carotid arteries including arterial diameter, peak systolic velocity, average velocity, and blood flow volume of forty patients who had undergone elective thyroidectomy under endotracheal anesthesia was done. Three sets of data (baseline, after induction, and after surgery) were collected and analyzed.Results:There was a significant reduction in the diameter (P = 0.002) and the blood flow (P = 0.0001) in both carotid arteries and an increase in peak and mean velocity which was more pronounced immediately after head positioning and persisted till the end of the procedure. There was no correlation between the hemodynamic parameters with the carotid artery diameter, blood flow, and velocity.Conclusions:The head-and-neck positioning during thyroidectomy surgery reduces the blood flow through the carotid arteries which continued till the end of the procedure.

Prospective evaluation of remifentanil-propofol mixture for total intravenous anesthesia: A randomized controlled study.

Application of total intravenous anesthesia (TIVA) may be considered as unpractical when compared with inhalational anesthesia. Although it is mostly not recommended, mixing intravenous agents is popular in clinical practice. The aim of the present study was to investigate the suitability of using remifentanil-propofol mixture (MIXTIVA) for TIVA. Adult patients with an American Society of Anesthesiologists grade of I-II scheduled for elective thyroidectomy were randomly allocated to 3 groups (n=32 for each) to receive TIVA with remifentanil and propofol infusions separately (control group, Group I) or with MIXTIVA infusion that contained remifentanil/propofol at a proportion of 2/1,000 or 3/1,000 (remifentanil concentration, 20 or 30 µg/ml in 1% propofol in Group II or Group III, respectively). The extubation time (the primary outcome of the study), the orientation time and number of patients in whom intraoperative hypotension, hypertension or bradycardia episodes were encountered during anesthesia were comparable among the groups. The mean remifentanil infusion rate in Group III was significantly higher than that in the other groups. The mean propofol infusion rates and mean bispectral index (BIS) scores during anesthesia were comparable among groups. Hypotension accompanied with a high BIS was encountered in one patient in Group III. In conclusion, compared to the standard TIVA technique using separate drug infusions, MIXTIVA infusion used for thyroidectomies did not result in any statistically significant difference in recovery and clinical outcomes. This technique may be considered as a practical implementation for busy ambulatory centers performing general anesthesia. The present study was retrospectively registered at clinicaltrials.gov (trial registration no. NCT04394897).

Perioperative Precedex: Whole New Ball Game or Whole New Ball of Wax?

Perioperative Precedex: Whole New Ball Game or Whole New Ball of Wax?

An Evaluation of the Effectiveness of Preemptive Ketamine for Postoperative Analgesia in Elective Thyroidectomy

Background: The use of preincision low-dose ketamine as a preemptive analgesic modality has been widely suggested. However, findings from previous studies have remained inconclusive. Materials and Methods: Eighty-two patients scheduled to have elective thyroidectomy under general anesthesia were recruited. The patients were randomly allocated into one of two groups, to receive either 0.5 mg/kg of ketamine intravenously or an equal volume of normal saline, 10 min before surgical incision. At the end of surgery, pain scores, time to first request for analgesic and total opioid requirement in 24 h postoperatively were recorded. Results: There was no significant difference in the postoperative pain scores, time to first requirement for analgesic, postoperative opioid consumption and satisfaction with analgesia between the two groups. The median pain scores at recovery, 2, 6, 12, and 24 h postoperatively for the ketamine and saline groups were not significantly different (P values 0.208, 0.185, 0.412, 0.590, and 0.854 respectively). The times to first request for analgesic were 86.00 ± 56.58 min in the ketamine group and 79.90 ± 68.05 min in the saline group (P = 0.357). The 24-h opioid (morphine) consumptions were 11.00 ± 3.16 mg in the ketamine group and 13.21 ± 5.87 mg in the control group (P = 0.275). Conclusion: This study concluded that the administration of preincision low-dose ketamine (0.5 mg/kg) did not produce a preemptive analgesic effect in patients who had an elective thyroidectomy.

Rising Cost of Thyroid Surgery in Adult Patients

BackgroundThe aim of this study is to describe the economic trends in adults who underwent elective thyroidectomy. MethodsWe performed a population-based study utilizing the Premier Healthcare Database to examine adult patients who underwent elective thyroidectomy between January 2006 and December 2014. Time was divided into three equal time periods (2006-2008, 2009-2011, and 2012-2014). To examine trend in patient charges, we modeled patient charges using generalized linear regressions adjusting for key covariates with standard errors clustered at the hospital level. ResultsOur study cohort consisted of 52,012 adult patients who underwent a thyroid operation. During the study period, the most common procedure changed from a thyroid lobectomy to bilateral thyroidectomy. Over the study period, there was an increase in the proportion of completion thyroidectomies from 1.1% to 1.6% (P < 0.001), malignant diagnoses from 21.7% to 26.8% (P < 0.001), procedures performed at teaching hospitals from 27.7% to 32.9% (P < 0.001), and procedures performed on an outpatient basis from 93.85% to 97.55% (P < 0.001). The annual increase in median patient charge adjusted for inflation was $895 or 4.3% resulting in an increase of 38.8% over 9 y. Higher thyroidectomy charges were associated with male patients, malignant surgical pathology, patients undergoing limited or radical neck dissection, experiencing complications, those with managed health care insurance, and a prolonged length of stay. ConclusionsDespite recent changes in thyroid surgery practices to decrease the economic burden of hospitals, costs continue to rise 4.3% annually. Additional prospective studies are needed to identify factors associated with this increasing cost.

The Effect of Intra-Operative Plethysmography Variability Index-guided Fluid Therapy on Serum Lactate Levels; A Randomized Double-blinded Clinical Trial

Background: Goal-directed fluid therapy may improve perioperative fluid management. This study aimed to evaluate the effects of Pleth variability index (PVI)-guided fluid therapy on changes in intraoperative serum lactate levels in comparison with liberal fluid therapy. Methods: This study was a randomized double-blinded clinical trial that was conducted in the operating room of a university hospital. Inclusion criteria comprised patients aged 18–60 years and classified as American Society of Anesthesiologists physical status class I and II, who were candidates for elective thyroidectomy. In total, 44 patients meeting the inclusion criteria were enrolled in the study and randomly assigned to two groups: the liberal and PVI groups. In both groups, 5 mL/kg bolus of normal saline was infused prior to the anesthesia induction. In the PVI group, 100 mL bolus of normal saline was administered every 5 min if the PVI remained &gt;13% during the operation. In the liberal group, continuous crystalloid infusion (5–6 mL/kg/h) was administered throughout the surgery. Arterial blood samples were taken, and serum lactate levels were measured following anesthesia induction and just before tracheal extubation. Results: In the PVI group, mean serum lactate decreased at the end of the surgery, with a difference of −0.6 ± 0.13 mmol/L, whereas it increased in the liberal group (0.070 ± 0.3, P&lt;0.05). Conclusion: In conclusion, we found that using intraoperative PVI-guided fluid therapy could decrease serum lactate levels and total fluid administration compared to the liberal method.

Treatment outcome of thyroidectomies performed under local anesthesia for nodular goiter patients attending at Banadir Hospital in Mogadishu Somalia

Background: Thyroidectomy; which involves the removal of total or part of the thyroid glandis a routinely performed surgery that may have perioperative risks and complications which can be life-threatening. Objective: Main objective of this study is to determine the incidence of postthyroidectomy complications at Banadir Hospital, and to put forward the clinical benefits of those which had been performed under local anesthesia.Materials and Methods: Present study; which is prospective in nature, was conducted on 25 patients between 18 and 70 years of age who were scheduled to undergo elective thyroidectomy beginning from May to July, 2017. Blood samples for calcium, albumin, thyroid hormone levels were collected pre-operatively; within 48 hours and 5 days post-operatively. Relevant data had been achieved from the medical achieve of the department.Results: Patients between 20 and 40 years of age occupied the highest percentage of population in the study. Two (8%) patients had records of previous thyroid surgery. Ultrasonographic (USG) evaluations revealed benign thyroid nodule for 23 (92%) patients, as 2 (8%) other patients were confirmed as malignancy on their fine needle aspiration cytology (FNAC) which had suspicious findings on ultrasonographic (USG) evaluations. 21 (84%) patients had pain as the chief complaint. 19(76%) patient operations had been performed under local anesthesia, while 6(24%) patients had undergone operations undergeneral anesthesia. Total thyroidectomy was performed for 10 (40%) patients, whereas the rest (n=15 (60%) were performed with subtotal, near total and partial (lobectomy, nodulectomy) resections. No permanent hypocalcemia was recorded during the postoperative period, though 2 (8%) patients had transient hoarseness due to laryngeal nerve injury and another 2 (8%) patients had findings of surgical site infections.Conclusion: Thyroidectomy procedure could end up with undesired outcomes like nerve paralysis or hypocalcemia even at most experienced hands. Considering that, definite and precise operation should be performed at once to prevent re-operations that could increase the rate of morbidity.International Journal of Human and Health Sciences Vol. 04 No. 03 July’20 Page : 222-225

Laryngeal mask airway reduces incidence of post-operative sore throat after thyroid surgery compared with endotracheal tube: a single-blinded randomized controlled trial

BackgroundSore throat is a remarkable complication after thyroid surgery with endotracheal tube (ETT). Many studies revealed that laryngeal mask airway (LMA) might reduce the incidence and severity of postoperative sore throat. However, little is known about the use of a flexible reinforced LMA (FLMA) in thyroid surgery. The purpose of this study was to explore the potential benefits of FLMA compared with ETT on postoperative sore throat.MethodsIn this prospective, single-blinded, randomized, controlled trial, ninety-six patients aged 20–80 years, scheduled for elective radical thyroidectomy under general anesthesia were enrolled. They were randomly divided into ETT group and FLMA group. All the included patients received total intravenous anesthesia (with propofol, fentanyl and rocuronium) and controlled mechanical ventilation during the surgery. Cuff pressure of ETT and FLMA were strictly controlled. Incidence and severity of postoperative sore throat, numbness and hoarseness at 1, 24, and 48 h after surgery was evaluated and compared between the two groups. Incidence and severity of buckling during extubation and the hemodynamic profile during intubation were also recorded and compared.ResultsThe incidence of sore throat and hoarseness was significantly lower in FLMA group than those in ETT group at 1 h, 24 h and 48 h postoperatively, as well as the severity of sore throat. Compared to ETT group, there was a significantly lower incidence of buckling during extubation and less fluctuation of HR and BP at 1 min and 3 min after intubation in FLMA group.ConclusionsPatients undergoing thyroid surgery with FLMA had less postoperative laryngopharyngeal symptoms when compared with ETT. The use of FLMA also achieved less buckling during extubation and better hemodynamic profiles during intubation.Trial registrationThe research was registered in Chinese Clinical Trial Registry (ChiCTR-IOR-15006602) on May 23th, 2015.

Use of Video laryngoscopy in a Patient with Huge Thyroid Mass: A Case Report

Video laryngoscopy has opened its way into airway management and continues to play a larger role in managing patients with difficult airway. Anesthesiologists use video laryngoscopy more often every day and therefore accept the risks of more challenging and difficult airway situations with more confidence. In the mentioned case below, a 45-year-old female with a large thyroid mass is presented to an academic based hospital, for elective thyroidectomy. The patient was intubated using a video laryngoscopy technique and the airway was secured. Video laryngoscopy helps secure difficult airways and could be chosen as first line option in such situations.