Multimodal anesthetic support for thyroidectomy
Background. The thyrotoxicosis is caused by both increased production and release of iodine thyroid hormones (thyroxin, triiodothyronine). It provokes the hypermetabolism, dysoxia, and impairs the function of vital body organs, primarily cardiovascular ones. Materials and methods. In 2016–2018, a total of 2135 patients with thyroid pathologies were operated in Lviv Regional Clinical Hospital. Thyroidectomy was performed in 1400 individuals, hemithyroidectomy — in 531, and 204 persons underwent thyroidectomy with lymphadenectomy. All patients were divided into two groups excluding any differentiation criteria of gender, age or severity of condition. In the control group of patients (n = 1422), anesthesia during the surgical intervention was performed by the TVA technology (injection of sodium thiopental — 7–9 mg/kg body weight (BW) or propofol — 2–2.5 mg/kg, fentanyl ~ 1.5 µg/kg BW, atracurium — 0.6 mg/kg BW, ditilin ~ 200 mg; tracheal intubation — artificial ventilation was performed (Volume Control Ventilation technology). Main anesthesia: propofol 150 ± 25 µg/kg/min + fentanyl 100 µg every 15–20 min of surgical intervention. The patients of the basic group (n = 713) were prescribed valerian medications the evening before the surgery. Prior to surgery, the patients were injected ondansetron (4 mg), dexamethasone (8 mg), dexketoprofen (50 mg), paracetamol (1000 mg). Induction in anesthesia was performed with propofol (2–2.5 mg/kg) or sodium thiopental (5 mg/kg), fentanyl 1.5 µg/kg, ketamine (0.5 mg/kg), lidocaine (0.15 mg/kg). The tracheal intubation was carried out after the injection of atracurium 0.4–0.6 mg/kg BW. Basic anesthesia was performed with propofol (8–6 mg/kg/h) or sevoflurane (flow anesthesia) + fentanyl 1.5 µg/kg (once if surgery duration was up to 70 min). Results. The duration of intervention in patients of the basic and control groups was 70 ±10 min and 75 ± 5 min, respectively, and didn’t differ significantly. The duration of the anesthesia (from the moment of tracheal intubation till extubation) was shorter in patients of the basic group — 78 ± 4 min. This index in patients of the control group was 92 ± 8 min (р < 0.05). The bispectral index screening was performed in patients of both groups. It was 46 ± 2 and 48 ± 2 in patients of control and basic groups, respectively and didn’t differ significantly. Hemodynamic indexes during surgical intervention in patients of both groups were not significantly different from one another. The pain severity by the visual analogue scale 30 and 60 min after surgery was also probably less expressed in patients of the basic group — 26 ± 4 mm and 34 ± 4 mm. The pain severity by the visual analogue scale in patients of the control group at 30 and 60 min of postoperative period was 44 ± 4 mm and 48 ± 6 mm, respectively, and was probably higher than in patients of the basic group (р < 0.05). The dose of fentanyl used during the surgical intervention was probably decreased in patients of the basic group (58.9 ± 4.8 ng/kg/min of postoperative period). In patients of the basic group, fentanyl dose was 98.8 ± 5.2 ng/kg/min. We consider that the above mentioned situation caused quicker recovery from anesthesia and less expressed nausea and vomiting in the postoperative period. In this case, our data correlate with the data of other studies. A total of 60–70 % of patients complained of headaches in the postoperative period. In our opinion, it is caused by the position of the patient with the head reversed backwards on the operating table. Amazingly, none of the patients of the basic group complained of the same headaches in the postoperative period. Conclusions. Anesthesia management during surgery for thyroid pathology using the technology of multimodal anesthesia enables the stability of hemodynamic indexes during the operation and significantly decreases the duration of anesthesia and its negative manifestations in the postoperative period.
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