Thyroid surgery performed on an overnight basis: a 17 years of experience

Objective This study aimed to evaluate the results of thyroid surgeries with hospitalization periods shorter than 18 hours performed in a surgical endocrinology service, correlating these results with type of procedure, the definitive diagnosis and complications associated with the procedure.Subjects and methods The procedures performed, complications associated, hospitalization period, and relationships among these variables were assessed in consecutive patients subjected to different types of thyroid surgeries from January 1997 to March 2014 by the same group of surgeons. Data were analyzed by frequency, and the associations between the hospitalization period and other variables were analyzed using the Pearson chi-square test and Fisher’s exact test, using a multiple comparisons test with Bonferroni correction.Results Among the 3,411 surgeries performed, 799 of them were malignant neoplasia, 2,505 were benign tumors and 107 were Graves’ disease. The following procedures were performed: total thyroidectomy (1597 patients); total thyroidectomy with neck exploration (369 patients); lobectomy plus isthmectomy (1084 patients); total thyroidectomy complementation (145 patients); total thyroidectomy with neck dissection (84 patients); modified radical total thyroidectomy (13 patients); nodulectomy (11 patients); unresectable (9 patients); central neck dissection (48 patients); lateral neck dissection (38 patients); and others (13 patients). The following surgical complications, characteristic of the procedure: hemorrhage in 41 (1.2%) patients, hypoparathyroidism in 10 (0.3%) patients and recurrent laryngeal nerve (RLN) injury in 23 (0.7%) patients. Hospitalization shorter than 18 hours was observed in 97% of patients.Conclusion Thyroid surgery can be safely performed in virtually all patients on an overnight basis in specialized services.

Dolor postoperatorio en niños: diagnóstico de situación en unidad de recuperación / Postoperative pain in children: diagnosis of situation in recovery unit

Objetivo: Estudio descriptivo. Evaluación nivel del dolor en el postoperatorio inmediato de pacientes pediátricos y su correlación con técnica analgésica del intraoperatorio. Método: A través de una pauta previamente diseñada, se evaluó a niños operados de cirugía electiva y urgencia e ingresados en las unidades de recuperación (UR) de 2 hospitales de Santiago. Se registró el tipo de analgesia del intraoperatorio y el nivel de dolor durante el postoperatorio inmediato de acuerdo a escala visual análoga. También se registró la analgesia de rescate. Resultados: 173 niños ingresaron al estudio (febrero a junio de 2004). Todos recibieron analgésicos durante el intraoperatorio. El 99 por ciento de los casos recibió más de una droga. El AINE más usado fue ketoprofeno (70.3 por ciento) y de los opioides, fentanyl (90.8 por ciento). El 73 por ciento de los casos fueron candidatos a bloqueo analgésico regional, el cual se realizó en el 42 por ciento de ellos. El 62 por ciento, presentaba un EVA <3 al momento del ingreso a recuperación. A los 30 min, el 81 por ciento tenía EVA <3 y a los 60 min 96 por ciento. Ningún paciente presentaba dolor al momento del alta. Fué necesario rescate (EVA >3) en 37 por ciento, de los pacientes al ingreso a la UR, 18 por ciento requirió rescate a los 30 min y sólo 3 por ciento a los 60. Se eligió un opioide en 59 por ciento de casos y AINES en 40 por ciento (confeccionar tabla). Conclusiones: Los resultados muestran que el dolor postoperatorio inmediato en pediatría, es en la mayoría de los pacientes de intensidad sólo leve a moderada. Esto debido probablemente al adecuado uso de analgesia multimodal durante el intraoperatorio. Además, responde favorablemente tanto a AINES como a opioides. También sugieren que los analgésicos opioides son la droga de elección para rescate analgésico. En ningún paciente hubo retraso del alta por motivo de dolor.

Objective: To survey the analgesic technique used during surgery and its postoperative effectiveness. A modified Visual Analog Scale (VAS) and Clinical Scale Measurement were obtained from 173 operated children, from two hospitals of Santiago. We also registered requesting of aditional analgesia. Results: In recovery room, at the arrival time (T0), VAS was < 3 in 62 percent, of our patients, in 81 percent and 96 percent at 30 and 60 min respectively. And 100 percent at discharge. The request of aditional analgesia at T0 (VAS >3) was registered in 37 percent children, and at 30 and 60 min in 18 percent and 3 percent respectively. The choice of an opiod was in 59 percent of cases and NSAID'S in 40 percent. Conclusions: All the children had their postoperstive analgesia started during the surgery. In 99 percent of the cases more than one drug was selected. Being ketoprofen the most common NSAID and fentanyl in the opiods. Regional blockades were used in 73 percent in whom it was suiteble. All our patients were discharged without pain and no further treatment was needed.

Comparison of immediate recovery period among young, middle-aged and elderly patients.

We reported the immediate recovery period of 705 consecutive patients post general or head-neck-breast surgery, 590 were looked after in the recovery room (RR) and 115 were admitted into the intensive care unit (ICU) right after surgery. Group I were "young" (aged 15-45 years), group II were "middle aged" (46-60 years) and group III were "elderly" (> 60 years). Twenty-seven per cent of the elderly patients were sent to the ICU, whereas, 8.4 per cent of the young and 14.7 of the middle-aged group were looked after in the ICU. In RR patients, the young group were in better ASA class and had significantly fewer underlying diseases than the middle-aged and elderly groups; the most common of which were hypertension, diabetes and anemia. Elderly patients spent a significantly longer time in the RR than the young group but the risk of complication was not different. The most frequent complication was pain and elderly patients more frequently suffered from pain than the young group. Post-anesthetic recovery score (after Aldrete and Kroulik) was lower in the elderly on arrival and at 15, 30, 60 minutes in the RR but there was no clinical significance. In ICU patients, the 3 groups' intubation rates were not different and although the duration of intermittent positive pressure ventilation and duration of stay in the ICU were longest in the elderly group, there was no statistically significant difference. The mortality rate was highest in the elderly. We concluded that elderly patients had a worse immediate recovery period.