scholarly journals SURGERY OF THYROID GLAND: OBJECTS AND UNSOLVED PROBLEMS

2015 ◽  
Vol 174 (1) ◽  
pp. 73-74 ◽  
Author(s):  
O. F. Bezrukov
Keyword(s):  
Thyroid Gland ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
Parathyroid Glands ◽  
Bleeding Prophylaxis ◽  
Damage Prevention

The author considers the problems for surgeons such as maintenance of trachea and the esophagus integrity, bleeding prophylaxis, damage prevention of recurrent nerves and parathyroid glands. The article proposed the measures of the edematous syndrome prevention in early postoperative period.

scholarly journals SURGICAL PREVENTION AND TREATMENT OF POSTOPERATIVE HYPOPARATHYROIDISM IN PATIENTS OPERATED ON THYROID GLAND

2020 ◽  
pp. 128-134
Author(s):  
A. Ya. Pasko
Keyword(s):  
Thyroid Gland ◽  
Blood Supply ◽  
Postoperative Period ◽  
Parathyroid Glands ◽  
Antioxidant Therapy ◽  
Fatty Tissue ◽  
Group I ◽  
Postoperative Hypoparathyroidism ◽  
Prevention And Treatment ◽  
Surgical Prevention

Abstract. Thyroid gland (TG) diseases are among the most common and occupy the second place in the structure of endocrine system diseases after diabetes mellitus. The main method of TG disease treatment remains the surgical one. With the increase in the incidence of various forms of TG pathology, the number of surgeries increases including the ones performed at non-specialized in-patient facilities leading to an increase in the frequency of postoperative complications. One of the most common specific complications after surgeries on TG is postoperative hypoparathyroidism (PHPT). It occupies a special place considering the severity of manifestations and the difficulty in prevention. It is usually caused by trauma or parathyroid glands (PTG) removal, their blood supply disturbance, as well as the development of fibrosis at the surgery site in the long term. Therefore, the improvement of existing technologies and the development of new approaches to surgeries in case of TG diseases are relevant today. The most common method of postoperative hypoparathyroidism (PHPT) surgical prevention is precision nature of surgical manipulations with careful adhering to tactical and technical requirements for the operator: identify parathyroid glands (PTG) timely, mobilize gently, and keep their blood supply. However, it is often impossible to keep PTG intact structurally and without ischemia due to the small sizes of PTG and their vessels, anatomical and embryological features of these organs localization, the consistency and color similarity with fatty tissue, lymph nodes. The objective of the research was to develop and evaluate the algorithm of prevention and treatment of postoperative hypoparathyroidism (PHPT) based on determining parathyroid glands (PTG) viability and the use of antihypoxant-antioxidant therapy in the postoperative period. The research was based on the results of a comprehensive examination and treatment of 60 patients who were operated for thyroid gland diseases. The patients underwent inpatient treatment at the surgical department of Ivano-Frankivsk Central City Clinical Hospital and Ivano-Frankivsk Regional Oncology Center from 2017 to 2020. We proposed an algorithm for surgical prevention and treatment of PHPT during thyroid gland surgeries which consisted in the following. We performed a visual assessment of PTG intraoperatively and evaluated each gland from 0 to 3 points according to the degree of its viability affection. If the gland was evaluated at 0-2 points, we left it, since there was a high probability of maintaining its function. If it was evaluated at 3 points, its autotransplantation was performed. Cytoflavin drug was applied in a dose of 10 ml per 200 0.9% NaCl intravenously once a day during 7 days in the postoperative period for the purpose of antihypoxant-antioxidant therapy. 2 groups of patients were formed in order to evaluate the effectiveness of the algorithm. Each group consisted of 30 people. Patients of Group I underwent surgery on thyroid gland according to generally accepted rules. Patients of Group II underwent interventions according to the above-mentioned algorithm. The use of our proposed algorithm (intraoperative assessment of PTG viability and antihypoxant-antioxidant therapy in the postoperative period) significantly reduces the frequency of permanent PHP justifying indications to its application.

scholarly journals Loss of signal during intraoperative neuromonitoring of laryngeal nerves as a predictor of postoperative larynx paresis: Analysis of 1065 consequetive thyroid and parathyroid operations. Surgeons' algorythm (tactics)

2017 ◽  
Vol 10 (3) ◽  
pp. 15-24
Author(s):  
Viktor A. Makarin ◽  
Anna A. Uspenskaya ◽  
Arseniy A. Semenov ◽  
Natalia I. Timofeeva ◽  
Roman A. Chernikov ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Negative Predictive Value ◽  
Sensitivity And Specificity ◽  
Postoperative Period ◽  
Predictive Value ◽  
Intraoperative Neuromonitoring ◽  
Parathyroid Glands ◽  
Laryngeal Nerves ◽  
Gland Tissue ◽  
Thyroid Gland Tissue

During thyroid and parathyroid operations performed with laryngeal nerves neuromonitoring, a segmental or global loss of signal may occur. The most frequent cause of loss of signal – is tension of thyroid gland tissue and at the same time tension of the laryngeal nerves. There is no consensus if this complication arises regarding surgeon’s actions.Aim. Evaluation of predictive value of loss of signal during IONM regarding larynx paresis in postoperative period, and algorithm suggestion in case of loss of signal develops.Materials and methods. 1065 patients were operated on thyroid and parathyroid glands with neuromonitoring of laryngeal nerves. Neuromonitore C2 (Inomed, Emmendingen, Germany) was used. We evaluated frequency of loss of signal, described types of loss of signal, showed sensitivity and specificity of loss of signal and development of postoperative larynx paresis.Results. Loss of signal developed in 32 (1,9%) patients. More frequently loss of signal was detected at left side (p=0,01, χ2 = 4,2 OR=2,9). Sensitivity (Se)  of loss of signal and postoperative larynx paresis development reached 59,2%, specificity – 99,7% (Sp), positive predicitive value (PPV) – 91,4%, negative predictive value (NPV) – 97,8%. There are no statistically reliable differences in recovery periods of larynx function depending on type of loss of signal (segmental or global) (p=0,5).Conclusions. In most cases loss of electromyographical signal indicates injury of laryngeal nerves during operation on thyroid and parathyroid glands. When there is loss of signal in case of bilateral thyroid gland disease it is reasonable to make a decision to stop operation to prevent development of bilateral larynx paresis.

scholarly journals Recovery of early postoperative muscle strength after deep neuromuscular block by means of ultrasonography with comparison of neostigmine versus sugammadex as reversal drugs: study protocol for a randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e043935
Author(s):  
Xuan Wang ◽  
Yingyuan Li ◽  
Chanyan Huang ◽  
Wei Xiong ◽  
Qin Zhou ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Muscle Strength ◽  
Neuromuscular Blockade ◽  
Postoperative Period ◽  
Controlled Trial ◽  
Complete Recovery ◽  
Early Postoperative Period ◽  
Time Points ◽  
Muscle Groups ◽  
Randomised Controlled

IntroductionDespite the use of quantitative neuromuscular monitoring together with the administration of reversal drugs (neostigmine or sugammadex), the incidence of residual neuromuscular blockade defined as a train-of-four ratio (TOFr) <0.9 remains high. Even TOFr >0.9 cannot ensure adequate recovery of neuromuscular function when T1 height is not recovered completely. Thus, a mathematical correction of TOFr needs to be applied because the return of a normal TOFr can precede the return of a normal T1 twitch height. On the other hand, different muscles have different sensitivities to neuromuscular blockade agents; thus, complete recovery of one specific muscle group does not represent complete recovery of all other muscles. Therefore, our study aims to assess the muscle strength recovery of respiratory-related muscle groups by ultrasound and evaluate global strength using handgrip dynamometry in the early postoperative period when TOFr=0.9 and corrected TOFr (cTOFr)=0.9 with comparison of neostigmine versus sugammadex as reversal drugs.Methods and analysisThis study will be a prospective, single-blinded, randomised controlled trial involving 60 patients with American Society of Anesthesiologists physical status I–II and aged between 18 and 65 years, who will undergo microlaryngeal surgery. We will assess geniohyoid muscle, parasternal intercostal muscle, diaphragm, abdominal wall muscle and handgrip strength at four time points: before anaesthesia, TOFr=0.9, cTOFr=0.9 and 30 min after admission to the post anaesthesia care unit. Our primary objective will be to compare the effects of neostigmine and sugammadex on the recovery of muscle strength of different muscle groups in the early postoperative period when TOFr=0.9 and cTOFr=0.9. The secondary objective will be to observe the difference of muscle strength between the time points of TOFr=0.9 and cTOFr=0.9 to find out the clinical significance of cTOFr >0.9.Ethics and disseminationThe protocol was reviewed and approved by the Ethics Committee of The First Affiliated Hospital, Sun Yat-sen University. The findings will be disseminated to the public through peer-reviewed scientific journals.Trial registration numberChiCTR2000033832.

Frailty syndrome as an independent predictor of unfavorable outcome in patients undergoing coronary artery bypass grafting

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Krivoshapova ◽  
O.L Barbarash ◽  
E.A Wegner ◽  
N.A Terentyeva ◽  
I.I Grigorieva ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Postoperative Period ◽  
Artery Bypass ◽  
Early Postoperative Period ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Risk Of Death

Abstract Purpose To assess the prevalence of frailty in the preoperative period and to evaluate its effect on the risk of complications and adverse outcomes in patients undergoing coronary artery bypass grafting (CABG). Methods 303 patients undergoing preoperative management for elective primary CABG were recruited in the study. The study cohort was divided into three groups depending on the PRISMA-7 scores suggesting the presence or absence of frailty and the presence of prefrailty. Statistical analysis was performed using the commercially available software package STATISTICA 8.0.360.0 for Windows (StatSoft, Inc., USA) and SPSS Statistics v. 17.0.0. Results 46 (15%) patients had frailty, while 49 (16%) patients were diagnosed with prefrailty. 208 (69%) patients did not have any signs of frailty. All three groups had significant age differences, therefore only elderly patients aged of 67.0±6.5 years with frailty were allocated for subsequent analysis (prefrailty group - 62.3±7.4 years old, patients without frailty - 60.0±7.7 years, p=0.003). Patients with frailty or prefrailty more often suffered from diabetes mellitus (patients without frailty - 19.2%, prefrailty group - 30.6% and frailty group - 28.3%, p=0.05), arterial hypertension (69.2%, 93.9% and 95.7%, respectively, p&lt;0.001), atrial fibrillation or flutter (7.2%, 14.3% and 19.6%, respectively, p=0.03), chronic heart failure class 3–4 (7.2%, 10.2% and 8.7%, respectively, p=0.002), and peripheral arterial disease (22.6%, 38.8% and 58.7%, respectively, p&lt;0.001). Three groups were comparable in main clinical and demographic parameters. There were no significant differences found in the incidence of postoperative atrial fibrillation or flutter (15.9%, 8.2% and 6.5%, respectively, p=0.07) and infections (1.9%, 0% and 4.3%, respectively, p=0.640). The incidence of myocardial infarction in the intra- and early postoperative period after CABG did not differ significantly between the groups (0.5%, 2% and 0%, respectively, p=0.328) as well as the incidence of stroke (2.4%, 2% and 0%, respectively, p=0.640). Patients with frailty and prefrailty had significantly higher cerebrovascular and cardiovascular mortality compared to those without frailty (8.2%, 2.2% and 0.5%, respectively, p=0.001). Conclusion Almost 15% of patients referred to CABG suffered from frailty. The presence of prefrailty or frailty increases the risk of death in the early postoperative period after CABG. Funding Acknowledgement Type of funding source: None

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