Abstract 187: Impact of General Anesthesia on Safety and Outcomes in the Endovascular Arm of IMS III

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Alex Abou-Chebl ◽  
Michael D Hill ◽  
Bernard Yan ◽  
Kevin Cockroft ◽  
Pooja Khatri ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Multivariable Analysis ◽  
Negative Association ◽  
Hospital Death ◽  
Data Set ◽  
Neurological Outcomes ◽  
Good Outcome ◽  
Increased Risk ◽  
Significant Difference ◽  
Iv Tpa

Objectives: Use of general anesthesia (GA) during endovascular therapy (ET) of AIS patients is controversial with some suggestion of worse outcomes and death. The IMS III trial permitted the study of the effect of GA in a prospectively collected data set to test two hypotheses: (1) intubation is associated with poorer outcomes and (2) there is no increase in the risk of SAH or sICH with local anesthesia (LA). Methods: IMS III was a randomized trial of IV tPA +/- ET in patients presenting within 3hrs of AIS onset. In addition to demographic and outcomes data (mRS, ICH, etc.), information was collected on GA use or not within 7hrs of stroke onset. A good outcome was defined as mRS≤2 at 90 days. A multivariable analysis adjusting for dichotomized NIHSS (8-19 vs. ≥20), age and time from onset to groin puncture was performed. Additional analyses of reasons for intubation are ongoing and will be part of the presentation. Results: Four-hundred-thirty-four patients were randomized to ET, 269(62%) with LA and 147(33.9%) with GA. They were evenly matched in demographics, medical comorbidities, time to tPA, time to groin puncture, 40minute post IV tPA bolus SBP and occlusion location/side. The baseline NIHSS were slightly lower in the LA group (median 16 vs. 18). The GA group was less likely to achieve a good outcome (RR 0.64, CI 0.49-0.84, p=0.001) and had a greater risk of in-hospital death (RR 3.11, CI 1.86-5.20, p<0.0001). There was an increased risk of SAH in the GA group (RR 1.79, CI 1.04-3.08, p=0.0364) but no statistically significant difference in sICH (RR 1.69, CI 0.79-3.61, p=0.18). The multivariable analysis confirmed the negative association between GA and good outcomes (RR 0.68, CI 0.52-0.90, p=0.0027). Conclusions: In the IMS III trial there was an association with worse neurological outcomes and increased mortality with ET under GA. Also, there was an association between GA and an increased risk of SAH. Although the reasons for these associations are not clear, these data support the use of LA when possible during ET.

scholarly journals Association of Proteinuria and Hematuria with Acute Kidney Injury and Mortality in Hospitalized Patients with COVID-19

2020 ◽  
Vol 45 (6) ◽  
pp. 1018-1032
Author(s):  
Imran Chaudhri ◽  
Richard Moffitt ◽  
Erin Taub ◽  
Raji R. Annadi ◽  
Minh Hoai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Invasive Mechanical Ventilation ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Hospital Death ◽  
Study Cohort ◽  
Icu Admission ◽  
Risk Of Death ◽  
Increased Risk

<b><i>Introduction:</i></b> Acute kidney injury (AKI) is strongly associated with poor outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19), but data on the association of proteinuria and hematuria are limited to non-US populations. In addition, admission and in-hospital measures for kidney abnormalities have not been studied separately. <b><i>Methods:</i></b> This retrospective cohort study aimed to analyze these associations in 321 patients sequentially admitted between March 7, 2020 and April 1, 2020 at Stony Brook University Medical Center, New York. We investigated the association of proteinuria, hematuria, and AKI with outcomes of inflammation, intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and in-hospital death. We used ANOVA, <i>t</i> test, χ<sup>2</sup> test, and Fisher’s exact test for bivariate analyses and logistic regression for multivariable analysis. <b><i>Results:</i></b> Three hundred patients met the inclusion criteria for the study cohort. Multivariable analysis demonstrated that admission proteinuria was significantly associated with risk of in-hospital AKI (OR 4.71, 95% CI 1.28–17.38), while admission hematuria was associated with ICU admission (OR 4.56, 95% CI 1.12–18.64), IMV (OR 8.79, 95% CI 2.08–37.00), and death (OR 18.03, 95% CI 2.84–114.57). During hospitalization, de novo proteinuria was significantly associated with increased risk of death (OR 8.94, 95% CI 1.19–114.4, <i>p</i> = 0.04). In-hospital AKI increased (OR 27.14, 95% CI 4.44–240.17) while recovery from in-hospital AKI decreased the risk of death (OR 0.001, 95% CI 0.001–0.06). <b><i>Conclusion:</i></b> Proteinuria and hematuria both at the time of admission and during hospitalization are associated with adverse clinical outcomes in hospitalized patients with COVID-19.

Molecular evaluation of HIF-1α gene variation and determination of its frequency, and association with Breast Cancer susceptibility in Saudi Arabia

2020 ◽  
Vol 20 ◽  
Author(s):  
Rashid Mir ◽  
Faisel M. Abu-Duhier ◽  
Ibrahim Altedlawi Albalawi
Keyword(s):  
Breast Cancer ◽  
Saudi Arabia ◽  
Cancer Patients ◽  
Genotype Distribution ◽  
Breast Cancer Patients ◽  
Data Set ◽  
Gene Variation ◽  
Increased Risk ◽  
Significant Difference ◽  
Inheritance Model

Aim: Hypoxia-inducible factor 1 (HIF-1) is responsible in regulating oxygen homeostasis in tissues. HypoxiaInducible Factor α (HIF1-α) is a central effector of the hypoxic response. HIF-1α protein overexpression has been shown to have prognostic relevance in breast cancer. HIF-1α polymorphism is associated with increased breast susceptibility reported by several case controls studies but results remained controversial. Therefore, we studied the relationship between the HIF1α gene polymorphism with the breast cancer risk in Saudi Arabia. Methods: This study was consisted of 114 histologically confirmed Breast cancer patients and 117 sex -matched healthy women. HIF-1α genotyping was done by Amplification refractory mutation system PCR method. The HIF-1α gene genotypes were correlated with different clinicopathological characteristics of breast cancer patients. Results: A significant difference was observed in genotype distribution of HIF-1α gene variation C1772T between breast cancer cases and sex matched healthy controls (p=0.001). Our findings showed that the HIF- 1α variant was associated with an increased risk of Breast cancer for HIF-1α CC vs CT genotype OR = 0. 38, 95% CI = (0. 22 -0. 65), P = 0.005) in codominant inheritance model. The significant association was reported for HIF1A for genotypes CC vs (CT+ TT) OR = 0. 39, 95% CI = (0. 231 -0. 67), P = 0.007) in dominant inheritance model tested. In case of recessive inheritance model, a significant association of HIF-1 alpha gene variants was reported for CC VS -(CC+ CT) vs TT) OR = 3.10, 95% CI = (0. 12- 77.03), P = 0.56). During the allelic comparison, A allele significantly increased the risk of Breast cancer with odd ratio (OR = 0. 66, 95% CI = 0. 53 -1. 21, P = 0.04) and risk ratio RR= 0. 51 (0. 32 -0. 80) P= 0.004). A significant association of HIF1α polymorphism was reported with stage as well as distant metastasis of the disease. Conclusion: A significant association of HIF- 1α-CT heterozygosity and T allele significantly increased the susceptibility and is associated with the metastasis of Breast cancer. Further studies with larger data set and well-designed models are required to validate our findings.

Risk Factors for Temporomandibular Joint Arthritis in Children with Juvenile Idiopathic Arthritis

2012 ◽  
Vol 39 (9) ◽  
pp. 1880-1887 ◽  
Author(s):  
MATTHEW L. STOLL ◽  
TYLER SHARPE ◽  
TIMOTHY BEUKELMAN ◽  
JENNIFER GOOD ◽  
DANIEL YOUNG ◽  
...  
Keyword(s):  
Risk Factors ◽  
Juvenile Idiopathic Arthritis ◽  
Temporomandibular Joint ◽  
Strong Association ◽  
Multivariable Analysis ◽  
Mouth Opening ◽  
Retrospective Chart Review ◽  
Clinical Information ◽  
Increased Risk ◽  
Significant Difference

Objective.To determine the prevalence and features of temporomandibular joint (TMJ) arthritis by magnetic resonance imaging (MRI) among children with juvenile idiopathic arthritis (JIA), and to identify risk factors for TMJ arthritis.Methods.A retrospective chart review was performed on 187 patients with JIA who underwent a TMJ MRI at Children’s Hospital of Alabama between September 2007 and June 2010. Demographic and clinical information was abstracted from the charts. Univariate and multivariate analyses were performed to identify risk factors for TMJ arthritis identified by MRI.Results.MRI evidence of TMJ arthritis was detected in 43% of patients, with no significant difference among JIA categories. The number of joints with active arthritis (exclusive of the TMJ) and the use of systemic immunomodulatory therapies were not associated with TMJ arthritis. Multivariable analysis revealed a strong association between mouth-opening deviation and TMJ arthritis (OR 6.21, 95% CI 2.87–13.4). A smaller maximal incisal opening and shorter disease duration were also associated with an increased risk of TMJ arthritis.Conclusion.TMJ arthritis was identified in a substantial proportion of children with JIA (43%) and affects all JIA categories. TMJ arthritis was present in some patients despite limited or otherwise quiescent disease and in the presence of concurrent systemic immunomodulatory therapy. Routine evaluation for TMJ arthritis by MRI is warranted for all children with JIA.

Abstract 19483: Assessment of Outcome in Patients With Acute Minor Ischemic Stroke Treated With Intravenous TPA

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sameer Sharma ◽  
Umair Afzal ◽  
Mubashir Pervez ◽  
Rochele Clark ◽  
Julius G Latorre ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Small Sample Size ◽  
Intervention Group ◽  
Small Sample ◽  
Minor Stroke ◽  
Good Outcome ◽  
Minor Ischemic Stroke ◽  
Significant Difference ◽  
Iv Tpa

Introduction: Minor acute stroke (NIHSS≤4) within 4.5 hours from symptom onset is a common reason for withholding intravenous (iv) Thrombolysis (TPA), due to potential risk of major bleeding with such treatment and assumed good outcome without intervention. This subgroup of patients was excluded from the landmark NINDS iv tPA trial as per the prespecified protocol and also from various recent clinical trials involving acute stroke. In a recent study of patients with Rapid Improving symptoms and Minor stroke who did not receive IV tPA, 28.3% could not be discharged home and 28.5% could not ambulate independently at the time of discharge (Smith et al 2011). The efficacy of iv TPA in Minor stroke has not been previously studied. Method: Retrospective review of consecutive patients with Minor stroke (NIHSS ≤4) arriving within 4.5 hours between January 2009-July 2013 was done. Outcome in patients who received IV TPA was compared with patients who did not receive any IV tPA. Good outcome was defined as mRS ≤2. Results: 186 patients were identified out of which 20 received iv tPA. The baseline median NIHSS was 2 in the non-intervention group vs 3 in the intervention group (p =0.001), more cardioembolic, cryptogenic and lacunar stroke in tPA group (40% vs 35.53%, 20% vs 14.46% and 30% vs 22.89% respectively) there was no other statistically significant difference between the baseline characteristics of the two groups. Median change in NIHSS from admission to discharge was 1 for non-tPA vs 2.5 for tPA(p<0.001) and good outcome at discharge was seen in 80% patients in tPA vs 69.28% in non-tpa group (p =0.321). 8-12 week follow up data was available for 100 patients (12 tPA patients). Mean mRS was 1.34 in non-tPA vs 1 in tPA group (p=0.430) Conclusion: Acute intervention in Minor stroke appears to be safe. We did not find any statistically significant difference in clinical outcome between the two groups; this is likely due to small sample size, short follow-up period, and other confounding factors that we cannot fully account for in a retrospective study. A prospective randomized control study is warranted to clearly delineate the effect of iv TPA in patients with Minor stroke.

Abstract WMP100: Excessive Blood Pressure Reduction Increases the Risk of Acute Kidney Injury After Intracerebral Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kenichi Irie ◽  
Kaori Miwa ◽  
Kanta Tanaka ◽  
Hajime Ikenouchi ◽  
Masafumi Ihara ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Acute Kidney Injury ◽  
Intracerebral Hemorrhage ◽  
Characteristic Curve ◽  
Blood Pressure Reduction ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Hospital Death ◽  
Stroke Registry ◽  
Increased Risk

Background: Elevated blood pressure (BP) in the first 24 hours of admission of acute intracerebral hemorrhage (ICH) has been the focus of intensive therapeutic investigation, although early intensive BP lowering addresses a concern about development of acute kidney injury (AKI). However, it is unclear as to the effect of BP measure including the absolute BP reduction and increased BP variability on AKI in patients with acute ICH. Methods: We retrieved data of consecutive patients with acute ICH from our prospective stroke registry between July 2015 and August 2017. We excluded patients with preexisting end-stage renal disease or in-hospital death within 24 hours. The primary outcome was AKI within 7days after admission defined using the AKI Network criteria. We recorded BP on emergency department arrival and for every 1 hour from 1 to 24 hours after admission (25 measurements). We measured mean systolic BP (SBP) and maximum minus minimum SBP within both 12 hours and 24 hours, and also quantified SBP variabilities (SBPV) including standard deviation, coefficient of variation, successive variation, and average real variability. Results: Among 361 patients with ICH (age 72.7±12.8, male 55%, non-lobar 76%), 31 (9%) developed AKI. For all SBP measure, the 12-hour SBP reduction was associated with the increased risk of AKI in multivariable analysis (odds ratio [per10 mmHg increase] 1.30; 95% CI 1.10-1.35). There was no significant association between the SBP variability and risk of AKI. The area under the receiver operating characteristic curve of the 12-hour SBP reduction for predicting AKI was 0.75. The association between the 12-hour SBP reduction and AKI was not modified by preexisting chronic kidney disease (interaction P=0.40). Conclusion: Early BP reduction in the first 12 hours of admission contributed to the risk of AKI in acute ICH. This may have clinical implication to avoid excess absolute BP reduction in patients with acute ICH.

Treatment Outcomes of Head and Neck Cancer Patients in the Elderly Receiving Different Chemoradiation Combinations: A Single-Center Experience

2021 ◽  
pp. 1-7
Author(s):  
Vidhya Karivedu ◽  
Marcelo Bonomi ◽  
Majd Issa ◽  
Adriana Blakaj ◽  
Brett G. Klamer ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Head And Neck ◽  
Chemotherapy Regimen ◽  
Single Agent ◽  
Locally Advanced ◽  
Multivariable Analysis ◽  
The Elderly ◽  
Increased Risk ◽  
Significant Difference ◽  
Weekly Cisplatin

<b><i>Objectives:</i></b> This study aimed to assess the effect of definitive or adjuvant concurrent chemoradiation (CRT) among elderly patients with locally advanced head and neck squamous cell carcinoma (LA HNSCC). <b><i>Materials and Methods:</i></b> We retrospectively analyzed 150 elderly LA HNSCC patients (age ≥70) at a single institution. Demographics, disease control outcomes, and toxicities with different chemotherapy regimens were reviewed. The Kaplan-Meier method was used to estimate progression-free survival (PFS) and overall survival (OS) estimates. <b><i>Results:</i></b> Median age at diagnosis was 74 years (range 70–88). Of the cohort, 98 (65.3%) patients received definitive and 52 (34.7%) received adjuvant CRT; 44 (29.3%) patients received weekly carboplatin and paclitaxel, 43 (28.7%) weekly cetuximab, 33 (22%) weekly carboplatin, and 30 (20%) weekly cisplatin. The OS at 2 years was 70% (95% confidence interval [CI]: 63–79%), and PFS at 2 years was 61% (95% CI: 53–70%). There was no significant difference in OS or PFS between definitive and adjuvant CRT (<i>p</i> = 0.867 and <i>p</i> = 0.475, respectively). Type of chemotherapy regimen (single-agent carboplatin vs. others) (95% CI: 1.1–3.9; <i>p</i> = 0.009) was a key prognostic factor in predicting OS in multivariable analysis. Concurrent use of cetuximab was associated with increased risk of PEG tube dependence at 6 months (<i>p</i> &#x3c; 0.001). <b><i>Conclusions:</i></b> Management of LA HNSCC in the elderly is a challenging scenario. Our study shows that CRT is a feasible treatment modality for elderly patients with LA HNSCC. We recommend CRT with weekly cisplatin or weekly carboplatin and paclitaxel. A chemotherapy regimen should be carefully selected in this difficult to treat population.

Increased Risk of Skeletal Toxicity and Infection in Children 10 Years or Older Treated for Acute Lymphoblastic Leukemia (ALL) with Dexamethasone: Results from the DFCI ALL Consortium.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 849-849 ◽  
Author(s):  
Lynda M. Vrooman ◽  
Donna Neuberg ◽  
Jane O’Brien ◽  
Stephen E. Sallan ◽  
Lewis B. Silverman
Keyword(s):  
Lymphoblastic Leukemia ◽  
Multivariable Analysis ◽  
Invasive Fungal Disease ◽  
P Value ◽  
Older Children ◽  
Childhood All ◽  
Treatment Groups ◽  
Increased Risk ◽  
Significant Difference

Abstract BACKGROUND: Dexamethasone (dex) may be more efficacious but also more toxic than prednisone (pred) in the treatment of childhood ALL. In order to compare the relative toxicities of these 2 steroids, patients (pts) on DFCI ALL Consortium Protocol 00–01 were randomized to receive dex or pred during post-induction therapy. METHODS: Pts received 5-day steroid pulses every 3 weeks for 2 years (yrs) (pred 40mg/m2/day or dex 6 mg/m2/day) beginning at week 7 of therapy. High Risk (HR) pts received 3 times these doses during the Intensification Phase (approximately 6 months). RESULTS: Between 2000–2004, 425 pts (ages 1–18 yrs) were randomized; 423 had evaluable skeletal toxicity data, including 241 Standard Risk (SR) and 182 HR pts. 211 received dex and 212 received pred. Within 26 months of enrollment, 55 pts (13%) experienced at least 1 bony event: 45 pts (11%) with fracture and 17 (4%) with osteonecrosis (ON). Bony events were more common in children ≥10 yrs of age (11% of those <10 yrs vs. 18.5% ≥10 yrs, p=0.007). There was no overall difference in frequency of pts with skeletal toxicity based on steroid type (see table, p=0.89), including no difference in fractures (11% dex vs. 10% pred, p=0.88) or ON (5% dex vs. 3% pred, p=0.23). However, skeletal toxicity was more common in dex-treated older children (≥10 yrs) compared with pred-treated older children (25% vs. 11%, p=0.07) and compared with younger (< 10 yrs) dex-treated pts (25% vs. 9%, p=0.004). There was no difference in frequency of skeletal toxicity by age in pred-treated pts (p=0.31). There was no difference in frequency of skeletal toxicity by steroid type in SR pts (8% dex vs. 14% pred, p=0.22) or in younger HR pts (12% dex vs. 11% pred, p=1.0). In multivariable analysis, children ≥10 yrs treated with dex had 2.7 times the risk of developing skeletal toxicity compared with all other pts (p=0.006). Of 404 pts with evaluable infection data, 37/200 (18.5%) dex-treated pts developed at least 1 infection (bacteremia and/or invasive fungal disease) during intensification or continuation compared to 24/204 (11.8%) pred-treated pts (p=0.07). There was no difference in infection rate by steroid type for those <10 yrs of age (p=0.53). However, for those ≥10 yrs, there were more infections in dex-treated than in pred-treated pts (24% vs. 5%, p=0.01). At 2.8 yrs median follow-up, there was no statistically significant difference in event-free survival (EFS) comparing dex- vs. pred-treated pts (90% vs. 88%, p=0.31), although there was a suggestion of inferior EFS in HR pts randomized to pred. Skeletal Toxicity and Infection: Dexamethasone vs. Prednisone* Dexamethasone Prednisone P value *Depicted are the numbers of pts with at least 1 toxicity event of all pts within particular subgroups. Skeletal Toxicity All 28/211 (13.3%) 27/212 (12.7%) 0.89 Age < 10 yrs 14/160 (9%) 22/166 (13%) 0.21 Age ≥ 10 yrs 13/51 (25%) 5/46 (11%) 0.07 Infection All 37/200 (18.5%) 24/204 (11.8%) 0.07 Age < 10 yrs 26/154 (17%) 22/160 (14%) 0.53 Age ≥ 10 yrs 11/46 (24%) 2/44 (5%) 0.01 CONCLUSION: Dexamethasone was associated with increased risk of skeletal toxicity and infection in pts ≥10 yrs of age. Longer follow-up is needed to fully assess EFS differences between the randomized treatment groups.

scholarly journals 664 The ICON Trauma Study: The Impact of the COVID-19 Lockdown on Major Trauma Workload in the UK

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Adiamah ◽  
A i Thompson ◽  
C Lewis-Lloyd ◽  
E Dickson ◽  
L Blackburn ◽  
...  
Keyword(s):  
Major Trauma ◽  
Injury Severity ◽  
Multivariable Analysis ◽  
Similar Time ◽  
Historical Cohort ◽  
Risk Of Mortality ◽  
Major Trauma Centre ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact

Abstract Introduction Anecdotal evidence suggest a direct impact of the SARS-COV-2-pandemic on presentation and severity of major trauma. Method This observational study from a UK Major Trauma Centre matched a cohort of patients admitted during a 10-week period of the SARS-CoV-2-pandemic (09/03/2020 to 18/05/2020) to a historical cohort admitted during a similar time period in 2019 (11/03/2019 to 20/05/2019). Demographic differences, injury method and severity were compared using Fisher’s and Chi-squared tests. Multivariable logistic regression examined the associated factors predicting 30-day mortality. Results Of 642 patients, 405 and 237 were in the 2019 and 2020 cohorts respectively. 1.69%(4/237) of the 2020 cohort tested SARS-CoV-2 positive. There was a 41.5% decrease in trauma admissions in 2020. The 2020 cohort was older (median 46 vs.40 years), more comorbid and frailer (p &lt; 0.0015). There was a significant difference in injury method with a decrease in vehicle related trauma, but an increase in falls. There was a 2-fold increased risk of mortality in the 2020 cohort that in adjusted models, was explained by higher injury severity and frailty. Positive SARS-CoV-2 status was not associated with increased mortality on multivariable analysis. Conclusions Patients admitted during the SARS-CoV-2-pandemic were older, frailer, more co-morbid and had an increased risk of mortality.

Intraoperative Nerve Monitoring in Thyroidectomies for Malignancy: Does it Matter?

2021 ◽  
pp. 000313482199196
Author(s):  
Shravan Leonard-Murali ◽  
Tommy Ivanics ◽  
Hassan Nasser ◽  
Amy Tang ◽  
Michael C. Singer
Keyword(s):  
Subgroup Analysis ◽  
Multivariable Analysis ◽  
Improvement Program ◽  
Data Set ◽  
Nerve Monitoring ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Complications Of Thyroidectomy ◽  
Intraoperative Nerve Monitoring ◽  
The Impact

Background Recurrent laryngeal nerve (RLN) injury and postoperative hypocalcemia are potential complications of thyroidectomy, particularly in malignancy. Intraoperative nerve monitoring (IONM) remains controversial. We sought to evaluate the impact of IONM on these complications using a national data set. Methods The American College of Surgeons National Surgical Quality Improvement Program thyroidectomy-targeted data set was queried for patients who underwent thyroidectomies from 2016 to 2017. Patients were grouped according to IONM use. Logistic regression models were constructed to evaluate associations of variables with 30-day hypocalcemic events (HCEs) and RLN injury. Associations were expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs). A subgroup analysis was performed of patients with malignancy. Results A total of 9527 patients were identified; 5969 (62.7%) underwent thyroidectomy with IONM and 3558 (37.3%) without. By multivariable analysis, IONM had protective associations with HCE (OR = .81, 95% CI = .68-.96; P = .013) and RLN injury (OR = .83, 95% CI = .69-.98; P = .033). Malignancy increased risk of HCE (OR = 1.21, 95% CI=1.01-1.45; P = .038) and RLN injury (OR = 1.22, 95% CI = 1.02-1.46; P = .034). A large proportion (5943/9527, 62.4%) of patients had malignancy; 3646 (61.3%) underwent thyroidectomy with IONM and 2297 (38.7%) without. In the subgroup analysis, IONM had stronger protective associations with HCE (OR = .73, 95% CI = .60-.90; P = .003) and RLN injury (OR = .76, 95% CI = .62-.94; P = .012). Discussion Malignancy was associated with increased risk of HCE and RLN injury. Intraoperative nerve monitoring had a protective association with HCE and RLN injury, both overall, and in the malignant subgroup. Intraoperative nerve monitoring was correlated with improved thyroidectomy outcomes, especially if the indication was malignancy. This warrants further study to clarify cause and effect.

scholarly journals Comparison of Hemodynamic Changes Due to Endotracheal Intubation With Labetalol and Remifentanil in Severe Preeclamptic Patients Undergoing Cesarean Delivery With General Anesthesia

2018 ◽  
Vol 7 (4) ◽  
pp. 515-519 ◽  
Author(s):  
Susan Rasooli ◽  
Farnaz Moslemi ◽  
Reyhaneh Ari ◽  
Hale Vazife Shenas ◽  
Majid Shokoohi
Keyword(s):  
General Anesthesia ◽  
Cesarean Delivery ◽  
Severe Preeclampsia ◽  
Double Blind Study ◽  
Double Blind ◽  
Apgar Scores ◽  
Mortality And Morbidity ◽  
Hemodynamic Variables ◽  
Increased Risk ◽  
Significant Difference

Objectives: Stress replication to laryngoscopy and intubation are exaggerated in the patient with severe preeclampsia and this stress can lead to an increased risk of maternal mortality and morbidity. The aim of this study was to compare the efficacies of remifentanil and labetalol in attenuating these responses in women with violent preeclampsia undergoing cesarean section (C-section) with general anesthesia. Methods: In this double-blind study, 70 women with violent preeclampsia undergoing cesarean delivery were randomly assigned to two groups to receive either remifentanil 1 µg/kg or labetalol 0.25 mg/kg before the induction of anesthesia. Then, blood pressure (BP) and heart rate (HR) were measured before and 1, 3, and 5 minutes after the intubation. The first and 5th-minute Apgar scores were evaluated as well. Results: All hemodynamic variables decreased in both groups after the administration of remifentanil or labetalol. Labetalol significantly attenuated the rise in BP and HR during laryngoscopy and intubation compared to remifentanil (P<0.001). Eventually, no significant difference was found between the Apgar scores of the two groups (P=0.97 and P=0.19, respectively). Conclusion: Overall, the administration of labetalol before the inspiration of anesthesia can control stress replication to laryngoscopy and shows better intubation and more stability than remifentanil in patients with severe preeclampsia undergoing C-section.

Sign in / Sign up

Export Citation Format

Share Document