Effectiveness and safety of electroacupuncture analgesia in controlling intraoperative pain and hemodynamics during total thyroidectomy:A randomized controlled trial

Objective:To evaluate the effectiveness and safety of electroacupuncture in conjunction with additional medications in providing analgesia and stabilizing hemodynamic parameters during total thyroidectomy.Methods:This randomized controlled trial included 100 patients who underwent a total thyroidectomy between October 2022 and October 2023 at the Vietnam National Hospital of Acupuncture.The patients were randomized into two groups.The electroacupuncture analgesia(EA)group received EA stimulation at five acupuncture points:Hegu(LI 4),Neiguan(PC 6),Shuitu(ST 10),Quepen(ST 12),and Yifeng(SJ 17),while the control group received a bilateral superficial cervical plexus block.Primary outcomes included the level of analgesia and perioperative vital signs in both groups.Additionally,pain thresholds and serum b-endorphin levels were measured before and after electroacupuncture in the EA group.Results:Complete analgesia(Level A)was attained in 86%and 76%of the patients in the EA and control groups,respectively,with no significant difference between the two groups(P=1.00).In the EA group,the mean pain threshold after receiving EA doubled(648.7(77.4)g/s vs.305.3(45.3)g/s,P<.001),and the mean serum b-endorphin level increased by approximately 13.5 pg/mL(P<.001).All patients remained hemodynamically stable throughout the surgery.Conclusion:EA,in conjunction with additional medications that stimulate five acupuncture points,LI 4,PC 6,ST 10,ST 12,and SJ 17,was well tolerated and effectively maintained a suitable level of analgesia and hemodynamic stability during total thyroidectomy.

Post Thyroidectomy Assessment of Intact Parathyroid Hormone for Early Prediction of Hypocalcaemia

Background: As the half-life of intact parathyroid hormone (iPTH) is very low, it reflects parathyroid insufficiency within minutes to hours after total thyroidectomy. Therefore, iPTH level assessment in the postoperative period can be used to predict the development of hypocalcaemia. The optimal time point to measure serum iPTH is important for the accurate prediction of hypocalcaemia. Aim: This paper aims to evaluate the ability of iPTH as an early predictive marker of hypocalcaemia and determine which time iPTH is more able to predict postoperative hypocalcaemia. Method: This prospective observational study was conducted in the Department of Otolaryngology-Head & Neck Surgery, BSMMU, Dhaka, from July 2020 to December 2021, with 67 patients who underwent total thyroidectomy. iPTH levels were measured on the day before the operation and at 1 hour, 4 hours, and 24 hours after the operation. S.calcium levels were measured on the day before the operation and 1st postoperative day. All the data were compiled and sorted properly and were analyzed statistically. Results: Postoperative hypocalcaemia developed in 18 cases, with an incidence of 26.9%. Pearson correlation showed a significant correlation between postoperative iPTH at 1 hr, 4 h, and 24 hr with 1st postoperative calcium value. The Receiver operating characteristic (ROC) curve was processed for the postoperative iPTH at 1 hr, 4 h, and 24 hr. The sensitivity, specificity, cut-off value, and mean AUC found 93.9%, 94.4%, ≤14.0, 0.988;95.9%, 94.4%, ≤09.5, 0.993 and 91.8%, 94.4%, ≤11.0, 0.993 respectively. Conclusion: iPTH can be used as an early predictor of post-thy-roidectomy hypocalcaemia. 4 hr iPTH showed more sensitivity and specificity for a cut-off value near the laboratory reference range.

Thyroidectomy: Frequency and Indications in the General Surgery Department of the Hôpital National Ignace Deen/CHU de Conakry

Introduction: Thyroidectomy is a surgical procedure to remove all or part of the thyroid gland. The aim of this study was to report the results of thyroidectomy in the general surgery department of the Hôpital national Ignace Deen/CHU de Conakry. Methodology: This was a retrospective study, of seven (07) years (January 1, 2016 - August 31, 2023), in the General Surgery Department of the Ignace Deen National Hospital-CHU in Conakry. We included all records of patients admitted and operated on for thyroidectomy and with up-to-date medical records. The variables were epidemiological, clinical and therapeutic. Results: During the study period, we recorded 3221 cases of surgery, including 40 thyroidectomies (1.24% of cases). The average age was 42.4 years. Women were the most represented, with a sex ratio of 0.16. The reason for consultation was anterior cervical swelling in 86% (n = 25) of cases, followed by signs of cervical compression 21% (n = 6) and signs of thyrotoxicosis 31% (n = 9). Indications for thyroidectomy were dominated by homogeneous goitres in 69% (n = 20) of cases, basedow’s disease in 20.7% (n = 6) and nodular goitres in 6.9% (n = 2) of cases. The surgical procedures were lobo-isthmectomies in 72.4% (n = 21), subtotal thyroidectomies 13.8% (n = 4), total thyroidectomies 10.3% (n = 3). Postoperative follow-up was straightforward in 69% (n = 20). Complications included haemorrhage in 20.7% (n = 6) and recurrence in 6.9% (n = 2). The average hospital stay was 7 days. Conclusion: Thyroidectomy is a relatively frequent surgical procedure in our department. Indications are dominated by homogeneous goitres. Morbidity is related to hemorrhage. Rigorous hemostasis could improve the quality of thyroidectomy.

Asymptomatic carbon dioxide embolism during transoral vestibular thyroidectomy:A case report

BACKGROUND Endoscopic thyroidectomy has obvious advantages over conventional surgical techniques in terms of postoperative cosmetic outcome.Although the incidence of carbon dioxide embolism(CDE)during endoscopic thyroidectomy is very low,it is potentially fatal.The clinical manifestations of CDE vary,and more attention should be paid to this disorder.CASE SUMMARY A 27-year-old man was scheduled for thyroidectomy by the transoral vestibular approach.The patient had no other diseases or surgical history.During the operation,he developed a CDE following inadvertent injury of the anterior jugular vein.The clinical manifestation in this patient was a transient sharp rise in end-tidal carbon dioxide,and his remaining vital signs were stable.In addition,loud coarse systolic and diastolic murmurs were heard over the precordium.The patient was discharged on day 4 after surgery without complications.CONCLUSION A transient sharp rise in end-tidal carbon dioxide is considered a helpful early sign of CDE during endoscopic thyroidectomy.

Video-assisted Endoscopic Thyroidectomy by the Breast Approach

Objective: To retrospectively evaluate the feasibility and clinical value of video assisted endoscopic thyroidectomy by the breast approach. Methods: From December 2002 to May 2003, 28 patients with a mean age of 28 years (range from 20 to 45 years) were selected and given video assisted endoscopic thyroidectomy by the breast approach. The subcutaneous space in the breast area and the subplatysmal space in the neck were bluntly dissociated through a 10 mm incision between the nipples, and CO 2 was insufflated at 6 8 kban to create the operative space. Three trocars were inserted in the mammary regions, and dissection of the thyroid and division of the thyroid vessels and parenchyma were performed endoscopically using an ultrasonically activated scalpel. The recurrent laryngeal nerve, the superior laryngeal nerve, and the parathyroid glands were preserved properly. Results: Among the patients, 3 were mass resections, 17 subtotal lobectomies, 2 total lobectomies, and 6 subtotal lobectomies plus contralateral mass resections. The mean operative time was (87.1±26.0) min; the mean estimated blood loss was (47.9±19.6) ml; and the mean postoperative hospital stay was (3.4±0.7) d. The drainage tubes were pulled out at 36 60 h postoperatively. There were no conversions to open surgery or complications. No scars left in the neck, and the patients were satisfied with the postoperative appearance. Conclusion: Video assisted endoscopic thyroidectomy using a breast approach and low pressure subcutaneous CO 2 insufflation is a feasible and safe procedure, which results in satisfactory appearance. We believe that video assisted endoscopic thyroidectomy by such approach will play a role in the future.

Total thyroidectomy is safer with identification of recurrent laryngeal nerve

Objective:To investigate the effect of recurrent laryngeal nerve(RLN)identification on the complications after total thyroidectomy and lobectomy.Methods:Total 134 consecutive patients undergoing total thyroidectomy or thyroid lobectomy from January 2003 to November 2004 were investigated retrospectively.Patients were divided into two groups:RLN identified (Group A)or not(Group B).The two groups were compared for RLN injury and hypocalcaemia.Results:The numbers of patients and nerves at risk were 71 and 129 in Group A,and 63 and 121 in Group B,respectively.RLN injury in Group A(0)was sig- nificantly lower than that in Group B(57.9%)patients,75.8%nerves)for the numbers of patients(P=0.016)and nerves at risk (P=0.006).Temporary hypocalcaemia was significantly higher in Group A than in Group B(1424.1%vs 610.3%,P=0.049). Permanent complications in Group B were significantly higher than those in Group A(1320.6%vs 45.6%,P=0.009).Con- clusion:RLN injury was prevented and permanent complications were decreased by identifying the whole course and branches of the recurrent laryngeal nerve during total thyroidectomy.

Drainage after total thyroidectomy or lobectomy for benign thyroidal disorders

Objective: This prospective randomized clinical trial was conducted to evaluate the necessity of drainage after total thyroidectomy or lobectomy for benign thyroidal disorders. Methods: A total of 116 patients who underwent total thyroidectomy or lobectomy for benign thyroidal disorders were randomly allocated to be drained or not. Operative and postoperative outcomes including operating time, postoperative pain assessed by visual analogue scale (VAS), total amount of intramuscular analgesic administration, hospital stay, complications, necessity for re-operation and satisfaction of patients were all assessed. Results: The mean operating time was similar between two groups (the drained and non-drained groups). The mean VAS score was found to be significantly low in the non-drained group patients in postoperative day (POD) 0 and POD 1. The mean amount of intramuscular analgesic requirement was significantly less in the non-drained group. One case of hematoma, two cases of seroma and three cases of transient hypoparathyroidism occurred in the non-drained group, whereas one case of hematoma, two cases of seroma, two cases of wound infections and two cases of transient hypoparathyroidism occurred in the drained group. No patient needed re-operation for any complication. The mean hospital stay was significantly shorter and the satisfaction of patients was superior in the non-drained group. Conclusion: These findings suggest that postoperative complications cannot be prevented by using drains after total thyroidectomy or lobectomy for benign thyroid disorders. Furthermore, the use of drains may increase postoperative pain and the analgesic requirement, and prolong the hospital stay. In the light of these findings, the routine use of drains might not be necessary after thyroid surgery for benign disorders.

Potential protection of indocyanine green on parathyroid gland function during near-infrared laparoscopic-assisted thyroidectomy: A case report and literature review

BACKGROUND In recent decades,significant advances have been made in protecting the parathyroid glands and recurrent laryngeal nerves during thyroidectomy.However,reliable and convenient technical means are still lacking.In this study,the reliability,safety and feasibility of near-infrared(NIR)laparoscopyassisted thyroid lobectomy with isthmectomy and prophylactic central lymph node dissection(CLND)were reported.CASE SUMMARY A 63-year-old female patient with a free previous medical history,was admitted to our department due to multiple thyroid nodules.Ultrasonic examination suggested diffuse thyroid changes and one thyroid nodule in the right upper lobe with the largest diameter of 1.5 cm adjacent to the trachea and Breast Imaging Reporting and Data System grade 4B.Imaging examination of the neck showed no obvious enlarged lymph nodes.Fine needle aspiration biopsy suggested a papillary thyroid carcinoma.Combined with thyroid function examination,the patient was diagnosed with papillary thyroid carcinoma and Hashimoto's thyroiditis.Considering the risk of invading the capsule and the patient's extreme anxiety,a right thyroid lobectomy with isthmectomy and prophylactic CLND was planned.No significant abnormalities were found during preoperative examinations,except for an increased thyroid stimulating hormone level.The patient underwent NIR laparoscopy-assisted thyroid lobectomy with isthmectomy and prophylactic CLND.During the operation,two right parathyroid glands(PGs)adjacent to the thyroid gland capsule and the right recurrent laryngeal nerve(RLN)were examined by indocyanine green(ICG)fluorescence using a NIR fluorescence camera,and the PGs and RLN were reliably preserved.Considering the ICG-positive PG,prophylactic CLND was performed.The postoperative parathyroid hormone level was in the normal range and no significant hypocalcemia symptoms were observed.CONCLUSION During NIR laparoscopy-assisted thyroidectomy,ICG fluorescence may aid PG identification and protection.

Thyroidectomy for Massive Goiter Weighing more than 500 Grams. Technical Difficulties, Complications and Management. Review

Background: Multinodular goiter is a relatively common thyroid disorder with a marked female preponderance. Most of these goiters weigh less than 100 grams with those weighing more than 500 grams being exceptional. The massively expanding goiter due to the strategic anatomic location of thyroid gland, in addition to being cosmetically disfiguring can seriously compromise the patency of the trachea and oesophagus. Thyroidectomy for such goiters is a surgical challenge due to the possible association of tracheomalacia, retrosternal extension, skin involvement and the difficulty in intubation and dissection of the thyroid gland due to distorted and displaced anatomy. Material and methods: While presenting 2 patients who underwent thyroidectomy for glands weighing more than 500 grams, the literature is reviewed to analyze the technical difficulties and approach in such patients and the frequently encountered complications in them and their management. Results: A review of the literature revealed an additional 7 cases of patients who had undergone thyroidectomy for glands weighing more than 500 grams. Massively enlarged goiter was often associated with tracheomalacia, tracheal stenosis and retrosternal extension. Difficulty during surgery was most often encountered in establishing the airway and in exposure of the gland particularly when the skin was involved. The predominant postoperative complications were related to respiratory distress as a consequence of tracheomalacia and tracheal stenosis. Conclusion: In spite of the technical challenge related to the airway, and thyroidectomy, surgery continues to be the best option in experienced hands due to its distinct advantage of its immediate effect and complete resolution of compressive symptoms.

Minimally invasive video-assisted thyroidectomy for thyroid adenoma

Objective： The aim of the study was to investigate the value of minimally invasive video-assisted thyroidectomy for thyroid benign adenoma. Methods： From June 2003 to June 2007, 128 cases of thyroid tumors, including 123 cases of adenoma and 5 cases of carcinoma, were performed by Miccoli＇s endoscopic thyroidectomy. The surgical techniques and the clinical outcomes with respect to pathologic results, duration of operation, postoperative drainage, pain, cosmetic results and complications of endoscopic thyroid surgery via the neck approach were retrospectively summarized. Results： NI the patients underwent minimally invasive endoscope-assisted thyroidectomy successfully. Five cases of carcinoma revealed by frozen section. In which, 3 papillary carcinoma cases underwent subtotal thyroidectomy of disease-side in video-assisting, whereas the other 2 cases with follicular and medullary carcinoma underwent conventional total thyroidectomy of disease-side combined with subtotal thyroidectomy of the opposite-side. The transient hoarseness occurred in one patient and recovered well one week later, and the other patients recovered successfully without any complications. Conclusion： Minimally invasive video-assisted thyroidectomy for thyroid adenoma is safe and reliable. This procedure offers a shorter incision, less invasion and better cosmetic results as compared with conventional thyroidectomy.

Optimum Timing and Complication of Completion Thyroidectomy for Differentiated Thyroid Cancer

Background: Despite improved preoperative diagnostics, incidental postoperative detection of differentiated thyroid cancer in the final histology is still common. In most of these cases, completion thyroidectomy is recommended by national and international guidelines, although secondary surgery is associated with an increased operative risk. The optimal timing of completion thyroidectomy is still controversial. Patients and Methods: The patients admitted to surgical oncology department, SECI, with diagnosis of differentiated thyroid cancer;during the period from January 2008 to December 2015;were rewired for age, sex, type of 1st operation, histopathological result, type of 2nd operation and time interval between the 2 operation, complication of 2nd operation and morbidity. 118 patients underwent completion thyroidectomy;those patients were divided according to timing of completion operation into 3 groups: Group A is from one week to 3 months and include 64 patients;Group B is from 3 - 6 months and include 30 patients;Group C is more than 6 months and include 24 patients. Clinical complications and oncologic outcomes were analyzed. The mean follow-up was 80 ± 10 months. Result: we record 118 patients under completion thyroidectomy. Ages range from 79 to 13 years. Papillary thyroid cancer were 96 and follicular thyroid cancer were 22. The overall rates of transient and persistent postoperative hypocalcemia were 19.5% and 4.2%, respectively. The rates of persistent hypocalcemia were found in group A and B but not in group C. Transient or persistent vocal cord paresis was observed in 9 (7.6%) and 3 patients (2.5%). The incidence of persistent vocal cord paresis (VCP) was significantly higher in groups A and B than in group C. There was no significant difference regarding survival among the 3 groups;however recurrence is higher in group A. Conclusion: Considering perioperative morbidity and oncologic outcomes, completion thyroidectomy should be performed at least 3 to 6 months after primary surgery.

Clinical Use of a Drain Incision Placed Below and Bilaterial to Near Total Thyroidectomy Incision

Objective： To design a new draining method for near total thyroidectomy at the lower two sides of the neck. Methods： Near total thyroidectomies in 63 cases were performed with new drain incisions at the lower two sides of the neck between December 1998 and July 2004. Results： All the draining operative procedures were performed smoothly, and all produced cosmetic scars were effective. The mean amount drained was 38 ml （minimum 10 ml, maximum 120 ml） and no patient developed wound infection. Conclusion： The drain incision for near total thyroidectomy placed at the lower sides of the neck results in a cosmetic scar which is easily covered by the collar, and was safe and effective. We thereby recommend the use of this drain incision for near total thyroidectomy.

Endoscopic thyroidectomy through anterior chest wall: a report of 28 cases

Objective: To retrospectively evaluate the feasibility and clinical value of endoscopic thyroidectomy through anterior chest wall. Methods: From December 2002 to May 2003, 28 patients with an average of age of 28 years old (rangeing from 20 to 45) were performed endoscopic thyroidectomy through anterior chest wall. The subcutaneous space in the anterior chest wall and the subplatysmal space in the neck were bluntly dissected through a 10-mm incision between the nipples, and CO 2 was insufflated at 6-8 mmHg to create the operative space. Three trocars were inserted in the mammary regions; and dissection of the thyroid, division of the thyroid vessels and parenchyma were performed endoscopically using an ultrasonically activated scalpel. The recurrent laryngeal nerve, the superior laryngeal nerve, and the parathyroid glands were preserved properly. Results: There were 3 mass resections, 17 subtotal lobectomies, 2 total lobectomies, 6 subtotal lobectomies plus contralateral mass resections. The mean operative time was (87.1±26.0) min; the mean blood loss during operation was (47.9±19.6) ml; and the mean postoperative hospital stay was (3.4±0.7) d. The drainage tubes were pulled out at 36-60 h postoperatively. There were no conversions to open surgery or complications. No scars can be found in the neck, and the patients were satisfied with the postoperative appearance. Conclusion: Endoscopic thyroidectomy through anterior chest wall combined with low-pressure subcutaneous CO 2 insufflation is a feasible and safe procedure. It can bring satisfactory cosmetic results. It is believed that endoscopic thyroidectomy by such approach will find a role in the future.

Thromboelastographic Profile of Patients with Hyperparathyroidism Secondary to Chronic Kidney Failure Submitted to Total Parathyroidectomy

Coagulopathy in surgical patients can cause perioperative complications, as both bleeding and thromboembolic events increase surgical morbimortality. The recognition of preexisting disorders and the understanding of the dynamic changes in hemostasis during surgery are prerequisites of safe patient management. The perioperative management of patients with chronic kidney failure is a huge challenge due to both the hypercoagulable state and increased risk of bleeding. Classic laboratory exams performed for the evaluation of blood clotting seem insufficient regarding the determination of the risk of bleeding and thrombosis in surgical patients. As patients with chronic kidney failure develop secondary hyperparathyroidism, the aim of the present study was to describe a case series and correlate the perioperative thromboelastographic profile of patients with chronic kidney failure submitted to parathyroidectomy with their secondary hyperparathyroidism.

Fluctuation of Corrected Serum Calcium Levels Following Partial and Total Thyroidectomy

Objectives: To identify any fluctuation of corrected serum calcium levels and to determine the presence of sub-clinical hypocalcaemia following partial and total thyroidectomy with preservation of at least two parathyroid glands. Design: A prospective study. Setting: Tertiary Head & Neck referral unit. Patients: Eighty five patients undergoing partial or total thyroidectomy with or without laryngectomy from April 2003 to April 2009 were included in the study. Corrected serum calcium levels (CCSL) were noted preoperatively and postoperatively on day 1, day 7 and 6 months. Results: Forty six patients underwent hemi-thyroidectomy (HT), 29 underwent total thyroidectomy (TT) and 10 underwent total thyroidectomy with laryngectomy (TTL). Nine (19.56%) patients in the HT group, 6 (24.14%) in the TT group and 3 (30.0%) in the TTL group developed hypocalcaemia postoperatively which was most significant on 1st postoperative day. This improved by 7th postoperative day in each group when the change in calcium levels became statistically insignificant. Six patients (3 patients had HT, 2 had TT and 1 had TTL) developed sub-clinical mild hypocalcaemia which was persistent at 6 months follow-up. Conclusion: The most significant changes in corrected serum calcium levels occur within first 24 hours after thyroid surgery. Thereafter most patients return to normocalcaemia within a seven-day period. Despite preservation of parathyroid glands there is a subgroup of patients who develop sub-clinical hypocalcaemia which persists even at six months but does not require treatment.

Total Thyroidectomy in Multinodular Goiter: An African Experience

Introduction: Total thyroidectomy is an operation that involves the surgical removal of the whole thyroid gland, with the preservation of the parathyroid glands. The aim of the present study was to assess the complication rates of total thyroidectomy on benign indication and first-time thyroid surgery and investigate the early outcome after opotherapy. Materials and Methods: In this retrospective study, patients who underwent total thyroidectomy for benign multinodular goiter in the department of thoracic surgery in our Hospital from January 2012 to December 2014 were included. In postoperative time, we evaluated surgical complication, histopathological examination and opotherapy. Results: A total 53 patients underwent total thyroidectomy for multmodular goiter;they were 49 (92.45%) bilateral and 4 (7.55%) unilateral (recurrence). The mean age was 47 years and mean diameter of goiter was 10.75 cm. Among the patients 88.68% were females and 11.32% were male. Preoperative hormonal statuses were (70%) in euthyroid and (30%) hyperthyroid following surgery complications like transient laryngeal nerve palsy (3.77%), transient hypocalcemia (7.55%), hematoma (1.9%) and wound infection (1.9%). On histopathological examination of the surgical specimen, 5.7% were reported to be malignant. Six month following surgery 92.45% of patients was a good hormonal balance. Conclusion: Total thyroidectomy for multinodular goiter has a low morbidity and mortality;this procedure olves both the problem of recurrence of disease and reintervention. The opotherapy is doable with a good hormonal balance.

Horner’s Syndrome after Thyroidectomy: Two Cases Report

Background: Horner’s syndrome is defined as a combination of a series of symptoms following the injury of oculosympathetic pathway. This dysfunction is usually acquired during cervical surgery but rarely triggered by thyroid-surgery. Case Presentation: Here we present two cases secondary to thyroidectomy. Two young female patients, both diagnosed as tumor in left lobe of thyroid, had Horner’s syndrome after surgery. Fortunately, Horner’s syndrome was relieved after steroid treatment. Conclusions: Indirect mechanism involved in the lesion and the direct factor with mistaken section of nerve fibers may be responsible for Horner’s syndrome. Besides, Horner’s syndrome after thyroid surgery may be revisable after oral steroid treatment.

Classic clamp-and-tie total thyroidectomy for large goiters in the modern era:To drain or not to drain?

AIM: To evaluate the role of drains in clamp-and-tie total thyroidectomy(c TT) for large goiters. METHODS: A hundred patients were randomized into group D(drains maintained for 24 h) and ND(no drains). We recorded epidemiological characteristics, thyroid pathology, hemostatic material, intraoperative events, operative time and difficulty, blood loss, biochemical and hematological data, postoperative vocal alteration and pain, discomfort, complications, blood in drains, and hospitalization.RESULTS: The groups had comparable preoperative characteristics, pathology, intraoperative and postoperative data. Hemostatic material was used in all patients of group ND. Forty patients in group D and 9 in ND felt discomfort(P < 0.001). CONCLUSION: Drains in c TT for large goiters give no advantage or disadvantage to the surgeon. The only "major disadvantage" is the discomfort for the patient. Inversely, drains probably influence surgeons' serenity,especially when c TT is performed in nonspecialized departments.

Analysis of the Effect of Anesthetics Comprising of Remifentanil Combined with Propofol During Thyroidectomy

Objective:To analyze the anesthetic effect of remifentanil combined with propofol during thyroidectomy.Methods:A total of 70 patients who underwent thyroidectomy during November 2018 to November 2019 in Chongqing Eleventh People’s Hospital were selected and recruited.These patients were divided into control group and observation group by random number table method.Each group consisted of 35 patients.The patients in the control group was given intravenous anesthesia comprising of propofol combined with intermittent fentanyl anesthesia,whereas the patients in the observation group was given intravenous anesthesia comprising of remifentanil combined with propofol.Results:The heart rate and mean arterial pressure of the observation group after anesthesia for 30 minutes were lower than those of the control group,and the differences were statistically significant(P<0.05).The total incidence of adverse reactions in the observation group was lower than that of the control group,and the differences were statistically significant(P<0.05).Conclusion:Remifentanil combined with propofol is effective in thyroidectomy.This combination can reduce the risk of adverse reactions and maintain stable hemodynamic parameters.

Therapeutic Management in Proximal Tracheal Rupture during Total Thyroidectomy

Tracheal disruption is a life-threatening rare complication of total thyroidectomy that it should be prevented. The own-patient risk factors, procedure of tracheal intubation and a meticulous surgical technique are three main keys to keep in mind. Both medical and surgical management of this injury depends on its size, location and patient’s symptoms although neither of them prevents late complications. An early diagnosis could improve with prognosis although it is mandatory to perform either respiratory functional or imaging study in order to assume its healing. When the tracheal laceration is diagnosed during the surgery, we should take care with a continuous monitoring of the patient’s vital signs. A good oxygenation will be succeeded in high volume and low pressure with endotracheal tube distal to the lesion. We advice placing a tube drain near the disruption to prevent emphysema and an early extubation to avoid an ischaemic damage of the mucosa. A postoperative suspicion of tracheal rupture could demand reintubation with the patient in full relaxation and an examination by CT-scan or fiberscope before deciding a simple supportive therapy. We present our therapeutic experience in a female patient who suffered from tracheal injury during total thyroidectomy and describe a review of literature.