Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study.

PURPOSE: The need for muscular relaxation to improve intubating conditions and to reduce the incidence of laryngeal morbidity is still controversial. The aim of this study was to determine the incidence of symptomatic laryngeal injuries (SLI) and of acceptable intubating conditions (including both good and excellent conditions), both with and without cisatracurium during induction of anesthesia, along with moderate doses of remifentanil and propofol. METHODS: In this prospective, randomized double-blind equivalence trial, the intubating conditions were compared in 130 ASA I or II female patients. All subjects received remifentanil 2 microg x kg(-1) i.v. and propofol 2.5 mg x kg(-1) i.v., with either cisatracurium 0.15 mg x kg(-1) i.v. (group Cisatracturium), or saline (group Placebo). Tracheal intubating conditions were assessed with the Copenhagen Score. A systematic screening for postoperative hoarseness and sore throat was performed 24 and 48 hr after anesthesia, followed by a nasofibroscopic examination when laryngeal symptoms persisted at 48 hr. RESULTS: Twenty-four hr after anesthesia, the incidence of postoperative hoarseness and sore throat in the Cisatracurium and Placebo groups was 26.5% and 21.5%, respectively, and 48 hr after anesthesia, the incidence was 7.8% and 6.1%, respectively (P = 0.32 and P = 0.50 between groups, respectively). In the clinically evaluable population, the incidence of SLI, assessed at 48 hr by nasofibroscopy, was equivalent in both groups, 1.6% vs 1.5% in group Placebo and group Cisatracurium, respectively (P < 0.001 for equivalence test), as was the occurrence of acceptable intubating conditions (95.4% vs 100%, P < 0.05 for equivalence test). However, the occurrence of excellent intubating conditions was more frequent in group Cisatracurium than in group Placebo (P = 0.0003). CONCLUSION: Following induction of anesthesia with propofol and moderate-dose remifentanil, cisatracurium did not confer a higher rate of good-to-excellent conditions for tracheal intubation, nor did muscle relaxation with cisatracurium decrease the rate of SLI after tracheal intubation.

Papillary thyroid microcarcinoma: incidence and prognostic factors.

The objective of this study was to define the prognostic factors of papillary microcarcinoma of the thyroid (PMCT), and to analyse their epidemiologic and histopathologic characteristics. Our series included 57 patients diagnosed with PMCT between 1994 and 2003 among 944 patients who underwent thyroid surgery. All the surgical specimens were examined in the same department of pathology using the same technique. The prognostic factors were elaborated from the results of the histological examination. The epidemiological and histopathological characteristics were also evaluated. Two sub-groups were distinguished: patients with node disease and/or with metastasis (17 patients) and patients without node disease and metastasis (40 patients). The architecture of PMCT was papillary in 14% of cases, follicular in 35% of cases and mixed in 49% of cases, with no significant difference between any two groups. Histopathologic characteristics such as the vascular extension, infiltration into the adjacent parenchyma or in the thyroid capsule are all indicative of a poor prognosis. Two categories of PMCT, with and without the risk of metastatic spread, can be identified from these prognostic factors.