A Comparison of the Efficacy and Safety of Tropisetron and Tropisetron Plus Dexamethasone as Antiemetics for Elective Thyroidectomy / 대한마취과학회지

BACKGROUND: Thyroidectomy is associated with a relatively high incidence of postoperative nausea and vomiting (PONV) ranging from 63% to 84%. In this study, we evaluated the safety and the antiemetic effects of tropisetron 30 microgram/kg or tropisetron 30 microgram/kg plus dexamethasone 5 mg in patients undergoing thyroidectomy under a standard anesthetic technique without narcotics. METHODS: Sixty-eight patients undergoing thyroidectomy were randomized to receive a placebo (Group C, n = 28), tropisetron 30 microgram/kg (Group T, n = 23) or tropisetron 30 microgram/kg plus dexamethasone 5 mg (Group T + D, n = 17) IV over 2 5 minutes immediately before the induction of anesthesia. The effects of these regimens on the development of PONV, adverse events and need for rescue antiemetics were analyzed for the 0 to 1 hour and 1 to 24 hours postoperative periods. RESULTS: In the 0 to 1 hour postoperative periods, the incidence of PONV in group C, T and T + D was 35.7%, 17.4% and 17.6% respectively, which showed no significant difference among the three groups (P > 0.05). In the same period, the incidence of retching or vomiting in Group C, T and T + D was 14.3%, 0% and 0% respectively, which showed a significantly lower incidence in Group T and T + D than Group C (P 0.05). During the first 24 hours postoperatively, the overall incidences of PONV was 67.9% for group C, 60.9% for group T and 58.8% for group T + D, which showed no siginificant difference among the three groups (P > 0.05). Group T + D patients had more headache compared to other groups, but there was no significant difference in theincidences of overall adverse events. CONCLUSIONS: Neither tropisetron or tropisetron plus dexamethasone was significantly different from the placebo for the prevention of PONV after thyroidectomy during the first 24 hour postoperative period. Only vomiting during the first 1 hour postoperatively was prevented in the tropisetron and combination of tropisetron plus dexamethasone groups compared to the control group.

Cervical Epidural Anesthesia for Thyroidectomy in a Patient with Tracheal Deviation: A case report / 대한마취과학회지

Large thyroid tumors present distortion of the airway, endocrine disturbance and metastatic effect. It may compromise airway directly or indirectly through dysfunction of the recurrent laryngeal nerve. The management of abnormal airway structure and the potential for both difficult intubation and surgical access to the airway are based on the principle of burning no bridges. Thyroidectomy can be performed under regional anesthesia using cervical epidural anesthesia in which maintenance of the airway and monitoring of recurrent laryngeal nerve function are possible. We describe a patient in whom a large thyroid mass with marked tracheal deviation was treated successfully by cervical epidural anesthesia and spontaneous respiration.

A Comparison of the Efficacy and Safety of Ondansetron, Droperidol and Ondansetron Plus Droperidol as Antiemetics for Elective Thyroidectomy / 대한마취과학회지

BACKGROUND: Thyroidectomy has been a surgical procedure associated with a high incidence of postoperative nausea and vomiting (PONV), and conventional antiemetics cannot prevent PONV effectively. In this study, we compared the efficacy and safety of ondansetron 70 microgram/kg, droperidol 10 microgram/kg and combination of both drugs to placebo in the prevention of PONV. METHODS: Seventy-six patients undergoing thyroidectomy were randomized to receive placebo (Group I, n=20), ondansetron 70 microgram/kg (Group II, n=19), droperidol 10 microgram/kg (Group III, n=18) and combination of both drugs (Group IV, n=19). The effects of these regimens on the incidence and severity of PONV and adverse events were analyzed for the 0 to 1 hour and 1 to 24 hours postoperative periods. RESULTS: In the 0 to 1 hour postoperative periods, the incidence of symptom free (no nausea and retching or vomiting) paients were 60% for placebo, 68.4% for ondansetron (p>0.05 versus placebo group), 88.9% for droperidol (p0.05 versus placebo group), 77.8% for droperidol (p0.05 versus placebo group), 77.8% for droperidol (p<0.05 versus placebo and ondansetron group), and 73.7% for combination of both drugs (p<0.05 versus placebo and ondansetron group). Also, there were no significant differences between the droperidol and droperidol plus ondansetron group. Among the side effects associated with antiemetics, headache and dizziness incidence was higher. CONCLUSIONS: Droperidol and combination of ondansetron plus droperidol was superior to placebo, and ondansetron for prevention of PONV during the first 24 hours postoperative period.

Thyroid Storm during Thyroidectomy of the Thyrotoxicosis Patient: A case report / 대한마취과학회지

It is uncommon that Anesthesiologist experience thyroid storm during the elective surgery because of marked reduction of operation for the treatment of hyperthyroidism owing to the development of radio-active iodide, antithyroid drugs and the use of beta-receptor blockers such as propranolol. In the treatment of Graves' disease, the conditions such as persistant symptoms of hyperthyroidism with resistance to the antithyroid drugs, frequent relapses and increasing size of thyroid gland must be considered for the need of surgery. It is essential to maintain the euthyroid state before surgery in these cases, if not, the possibility of thyroid storm is increased from increased release of thyroid hormones owing to manipulation of surgery. In our case, the patient had been medicated for 6 years, however, the euthyroid state had not been achieved before the day of surgery. Under the judgement of difficulty for more control of hyperthyroidism the surgeon requested for operation without delay. Immediately after starting operation, the symptoms suggesting thyroid storm such as the abrupt onset of high fever, the increasing blood pressure and heart rate were occured. The sugery was stopped and then the management for thyroid storm was begun. At arterial blood gas analysis, respiratory acidosis and metabolic acidosis were developed and increased hilar haziness suggesting severe pulmonary edema were present in both lung fields at chest x-ray. The patient was mechanically ventillated until improvement of metabolic and respiratory acidosis and pulmonary edema. Two days after operation, vital signs were stabilized and the patient was transferred to general wards.