Comparison Between Sevoflurane and Propofol With Remifentanil Anesthesia Avoid Neuromuscular Blocking Agent After Intubation in Thyroid Operation

Background: The goal of the study is to compare sevoflurane and propofol with remifentanil anesthesia avoid neuromuscular blocking agent after intubation in thyroid operation with intra-operative neuromonitoring.Methods: 80 patients scheduled to receive thyroid operation were randomly assigned to sevofluraneor propofol anesthesia maintained group. The time of rocuronium recovery profile were monitored. Adverse events such as sinus bradycardia, tachycardia, hypertension, hypotension and movement were recorded. Analyze the time from anesthetic stop to the extubation time and operation time. Record the incidence rate of sore throat, drowsiness, agitation, nausea and vomiting after extubation. Record the first neuromonitoring time and the number of successful neuromonitoring.Results: There were significant differences in the recovery profile of rocuronium between sevoflurane and propofol group(P<0.05). The incidence of hypotension was similar between sevoflurane and propofol group. There was no significant difference of sinus braducardia between the two groups. The incidence of movement was less in sevoflurane compared to propofol(12.% vs. 47.5%, P=0.002). The propofol group had longer extubation time than sevoflurane group(13.10±1.52 vs. 8.07±1.07 min, P=0.001).The incidence of sore throat, drowsiness, agitation, nausea and vomiting in the two groups was similar during the recovery period, and the difference was not statistically significant. There was no significant difference of neuromonitoring between the two groups.Conclusion: Sevoflurane has advantage with less movement adverse effects in thyroid surgery with intra-operative neuromonitoring compared to propofol when associated with remifentanil 0.1μg/kg/min in general anesthesia.Trial registration: Chinese Clinical Trial Registry (ChiCTR1800017166, 15 July 2018)

latrogenic and Idiopathic Vocal Cord Paralysis: A Real Obligation of Endoscopic Appraisal

Background: Thelarynx is an inevitable mouthpiece of the human body which has to execute very associated assignment like protection, respiration, and phonation. To fulfill this mission, the larynx should be accommodated, integrated, and sensible. The vocal cord is the concern of larynx, which served all-purpose. If any occurrence due to iatrogenic, idiopathic, or any other causes shut down the vocal cord mobility, the patient is facing miserable complexity in their life. Methods: It is a cohort retrospective study of 67 cases in the department of otolaryngology and Head-Neck Surgery, Bangladesh, from 01 July 2016 to 31 June 2019. Results: Incidence among outpatient was 0.06%, inpatient was 0.37%, and total laryngeal disorder, and thyroid operation was 6.51%. Of them unilateral was 64(95.52%) in which both right and left were equal 32(50%) bilateral were 3(2.99%), male were 28(41.79%), and females were 39(58.21%). Amidst them 00-18 years were 2(2.99%), 19-40 years were 21(31.34), 41-60 years 36(53.73%) and above 60 years 8(11.94%), smokers were 34(50.74%), betel leaf chewer 26(38.81%), diabetic were 27(40.30%), hypertensive were 19(28.36%), iatrogenic were 33(49.25%), idiopathic 20(29.85%) and others 14(20.90%), 61(91.05%) treated conservatively, 5(7.46%) surgical, and 1(1.49%) denied the repeated surgery.