ABSTRACT
Introduction: Resistant epileptic episodes, such as refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE), are neurological emergencies that require immediate medical treatment. Although inhalational anesthetics, such as isoflurane (ISO), have been proposed as a means of seizure control in dogs, there is currently a lack of both experimental and clinical studies on this subject. Study design: This is a retrospective clinical study. Methods: Records of dogs that received ISO for the management of RSE and SRSE during their intensive care unit (ICU) hospitalization at the Companion Animal Clinic of the Aristotle University of Thessaloniki were included in the present study. The study period spanned from February 2013 to March 2023. Dogs were identified as responders (R) when RSE/SRSE ceased after ISO administration, and the dogs were successfully discharged from the ICU after ISO discontinuation. Dogs were identified as non-responders (NR) when RSE/SRSE ceased after ISO administration, but RSE/SRSE reoccurred after ISO discontinuation. Additional data about the number and time of ISO cycles, the time of ICU hospitalization, the side effects of ISO administration, and an additional administration of antiepileptic drugs (AEDs) and anesthetic drugs were also recorded. Results: A total of 20 dogs with 26 recorded RSE/SRSE episodes and 26 anesthetic cycles with ISO were included in the present study. The clinical termination of seizure activity was achieved 100% (26/26) in all episodes. In 73.1% (19/26) of the episodes, ISO administration resulted in successful RSE/SRSE treatment. Poor outcome was recorded in 26.9% (7/26) of the episodes because RSE/SRSE reoccurred after ISO discontinuation, and the dogs were euthanatized or died due to cardiac arrest. Inspiratory ISO ranged between 0.5 and 4.0%. The median time of the anesthetic cycles with ISO was 12.67 h (4.00-62.00). The median duration of the ICU hospitalization was 48.00 h (24.00-120.00). At least one ISO-related side effect was recorded in 23 out of 26 (88.5%) episodes. Conclusion: To the authors' knowledge, this is the first clinical study that addresses the administration of ISO for RSE/SRSE treatment in dogs. The use of ISO may be beneficial in terminating RSE/SRSE; however, further prospective studies are necessary to confirm this observation.
ABSTRACT
BACKGROUND: The use of intraoperative neuromonitoring (IONM) provides surgeons with real time information about recurrent laryngeal nerves (RLN) functional integrity. Hence, allowing them to modify the initially scheduled bilateral procedure, to a two-stage thyroidectomy in cases of loss of signal (LOS) on the first side of resection resulting in minimization of bilateral RLN injury. The purpose of our study was to present our results since the implementation of the above mentioned process in both malignant and benign thyroid disease. METHODS: We conducted a retrospective, observational cohort study of prospectively collected data from all patients who underwent a scheduled total thyroidectomy with or without neck dissection in our Department over the last 4 years [2013-2016]. From the 1,138 patients who received surgical treatment during that period, 284 were excluded since they did not meet the criteria. Exclusion criteria involved previous neck operation, parathyroid surgery, pre-existing vocal cord palsy (VCP) and unilateral surgery. A total of 854 patients were eligible for our study. All patients were subjected to pre- and postoperative indirect laryngoscopy by the same experienced ENT specialist team and all the surgeries were performed by the same experienced team. The whole procedure followed the International Neural Monitoring Study Group's (INMSG) Guideline Statement. RESULTS: We experienced 70 cases (70/854, 8.2%) with postoperative VCP. Two of them (0.23%) had permanent VCP and the rest of those patients (7.97%) experienced transient VCP. Twenty-three (2.7%) patients were candidates for staged thyroidectomy after LOS on the first side of resection, including ten patients with papillary or medullary thyroid carcinoma and one with toxic multinodular goiter (MNG). Of those patients, 22 incidents of VCP (95.7%) have recovered within two months and one of them persisted for more than six months (permanent VCP). We did not experience any permanent bilateral RLN palsy after the implementation of the staged procedure. CONCLUSIONS: Staged thyroidectomy seems a very attractive and promising procedure for both patient and surgeon, since it nearly eliminates one of the most fearful complications in thyroid surgery. We suggest staged thyroidectomy in all cases with first side of resection signal loss, even in malignancies, since the benefits are much more than the disabilities in a patient's morbidity and quality of life.
