Personalized approach to perioperative anaesthetic management of thyroidectomy in patients with thyrotoxicosis
Background. The multiplicity of target organ damages among the patients with thyrotoxicosis, indecisive benefits of inhalation anaesthesia (IA) or total intravenous anaesthesia (TIVA) in thyroidectomy, advantages or disadvantages of using regional anaesthesia, the lack of data about the IA and TIVA effects on central haemodynamics in thyrotoxicosis patients during thyroid surgery require further research, improvement of anaesthetic management in the perioperative period, and the development of a patient-oriented approach. The purpose of the study was to improve the results of anaesthesia organisation in surgical treatment of thyrotoxicosis patients by choosing the anaesthesia method and optimizing perioperative anaesthesia. Materials and methods. At the first stage, the study concentrated on retrospective (2015) and prospective analysis (2016–2017) of 440 cases and anaesthetic maps of thyrotoxicosis patient who underwent thyroid surgery in 2015–2017 in order to identify the type of concomitant pathology and its incidence, the specific features of general anaesthesia depending on the type of anaesthesia (TIVA or IA) and its complications. The second stage included a prospective study involving 175 thyrotoxicosis patients undergoing thyroidectomy. Results. The evidence from this study suggests that the overwhelming majority of thyrotoxicosis patients undergoing thyroidectomy (67.7 %) are the persons with diffuse toxic goitre (DTG), 23.6 % — with multinodular goitre (MNG) and thyrotoxicosis syndrome; 5.0 % — with toxic thyroid adenoma; the rest were the patients with recurrent DGT or MNG and individuals with combined thyroid pathology (thyroid cancer due to DGT or toxic MNG). According to American Society of Anesthesiologists (ASA) only 105 patients (23.9 %) of the total amount had a minimal anaesthetic risk — ASA I, the rest — ASA II–IV. The number of patients with ASA III was as follows: 33.7 % in the MNG group, 50.0 % in the MNG group with papillary cancer and 13.8 % in the group with DTG. Conclusions. The results of this study indicate that thyrotoxicosis deteriorates the physical status of the patient according to ASA. 76.1 % of 440 patients with thyrotoxicosis had ASA II–IV. 21.1 % of patients were at high risk — ASA III and IV. The study shows the negative impact of IA with sevoflurane and TIVA with propofol on the hemodynamics and oxygen delivery. Our investigations in this field seem likely to confirm the hypothesis that combined anaesthesia with bilateral superficial cervical plexus block performed as a pre-emptive analgesia using minimal flow inhalation anaesthesia with sevoflurane or TIVA with propofol provides statistically (p < 0.05) significant improvement in pain relief compared to monoanaesthesia.
Cherenko MS. The current opinion on management and treatment of hyperthyroidism and other forms of thyrotoxicosis: review of the latest Guidelines of American Thyroid Association (2016). Clinical endocrinology and endocrine surgery. 2016;(56):87-93. doi: 10.24026/1818-1384.4(56).2016.87324. (in Ukrainian).
Sundaresh V, Brito JP, Wang Z, et al. Comparative Effectiveness of Therapies for Graves’ Hyperthyroidism: A Systematic Review and Network Meta-Analysis. J Clin Endocrinol Metab. 2013 Sep;98(9):3671-7. doi: 10.1210/jc.2013-1954.
Kale S, Shipra A, Vineet S, Chintamani. Evaluation of the Analgesic Effect of Bilateral Superficial Cervical Plexus Block for Thyroid Surgery: A Comparison of Presurgical with Postsurgical Block. Indian J Surg. 2015 Dec;77(Suppl 3):1196-200. doi: 10.1007/s12262-015-1244-5.
Larin OS, Cherenko SM, Tarasenko SO, Dubrov SO, Horobeyko MB, Kulish IO. Anaesthetic management of thyroidectomy in patients with thyrotoxicosis: the optimization of opioid-sparing effect and antiemetic component. Bilʹ, zneboluvanna i intensivna terapia. 2016;(75):5-18. doi: 10.25284/2519-2078.2(75).2016.83981. (in Ukrainian).
Terada T, Oiwa A, Maemura Y, Robert S, Kessoku S, Ochiai R.. Comparison of the ability of two continuous cardiac output monitors to measure trends in cardiac output: estimated continuous cardiac output measured by modified pulse wave transit time and an arterial pulse contour-based cardiac output device. J Clin Monit Comput. 2016 Oct;30(5):621-7. doi: 10.1007/s10877-015-9772-x.
Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999 Sep;91(3):693-700. doi: 10.1097/00000542-199909000-00022.
Tarasenko SO, Dubrov SO, Kunatovskiy MV, Smoliar VA. The volatile anesthetic consumption: the evaluation methods and correlation between them Bilʹ, zneboluvanna i intensivna terapia. 2017;(78):54-66. doi: 10.25284/2519–2078.1(78).2017.103518. (in Ukrainian).
This work is licensed under a Creative Commons Attribution 4.0 International License.
© "Publishing House "Zaslavsky", 1997-2018