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Anesthesia for Thyroid Surgery
Published in Madan Laxman Kapre, Thyroid Surgery, 2020
Vidula Kapre, Shubhada Deshmukh, Pratibha Deshmukh, Meghna Sarode, Rajashree Chaudhary
While thyroid surgery is the most common endocrine surgery performed across the world [1], it can be very challenging for the surgeons as well as the anesthesiologists. Anesthesia management for thyroid surgery is particularly demanding because it can pose problems to the anesthesiologist during the pre-operative, intra-operative, and post-operative periods. Pre-operatively, the issues are metabolic if the patient is not euthyroid and airway management in case of large goiters.Intra-operatively, the main concerns are the cardiovascular changes due to hypo- or hyperthyroidism. They are further compounded by the use of anesthetic drugs and endotracheal intubation. In addition, the requirement of the anesthesiologist during the intra-operative period is to provide stable hemodynamics to reduce the risk of hemorrhage due to the large vessels in the vicinity.Post-operatively, anesthesiologists are likely to face critical events due to airway compromise either because of a large hematoma or bilateral recurrent laryngeal nerve damage.
Telementoring in India: Experience with endocrine surgery
Published in Richard Wootton, Nivritti G. Patil, Richard E. Scott, Kendall Ho, Telehealth in the Developing World, 2019
Saroj K. Mishra, Puthen V. Pradeep, Anjali Mishra
In 1999, the Department of Endocrine Surgery at the SGPGIMS started experimenting with the use of videoconferencing to deliver education to a remote medical college. This followed a successful trial of multisite videoconferencing of a four-day postgraduate course in endocrine surgery and a workshop on minimally invasive endocrine surgery. Endocrine surgery, as a subspecialty of surgery, is not well developed in India. To facilitate knowledge exchange across the country, the department carried out a technical trial. Gradually, the educational interest expanded to include remote health care delivery. More projects began, and the telemedicine infrastructure grew. Currently, the infrastructure at the SGPGIMS telemedicine centre consists of several telemedicine workstations, equipped with teleradiology, pathology and videoconferencing units with large display devices. It can carry out medical data transfer and videoconferencing with six remote locations simultaneously.
Adult Anaesthesia
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Daphne A. Varveris, Neil G. Smart
Thyroid surgery is the most common endocrine surgery and is almost always elective. Indications include thyroid cancer, symptomatic goitre or failure of medical treatment in hyperthyroidism. Patients with uncontrolled myxoedema or hyperthyroidism are at considerable risk and pre-operative management seeks to achieve a euthyroid state.
Hemodynamic Instability during Thyroidectomy in Graves’ Disease
Published in Journal of Investigative Surgery, 2022
Sami Acar, Candas Ercetin, Nuri Alper Sahbaz, Fırat Tutal, Yunus Yapalak, Fulya Cosan, Yesim Erbil
Patients with GD who came to the outpatient clinic were primarily treated with ATDs. The first dose was administered as methimazole (MMI; 10–30 mg/day) or propylthiouracil (PTU; 100–400 mg/day). The serum levels of thyroid hormones were monitored and the drugs were gradually adjusted to keep the patients in the euthyroid state. Among these patients, those who received this treatment for at least 6 months and were followed for at least 1 year were included in the study. Beta blockers were added to the treatment of patients showing symptoms of cardiac arrhythmia and palpitations. Patients were directed to surgery when they had large goiters with compressive symptoms or suspicious nodules, were pregnant or lactating, were unresponsive or intolerant to ATDs, or expressed a preference to have surgery. All patients scheduled for operations underwent surgery while in the euthyroid state. A total thyroidectomy was performed by the same endocrine surgeon in all patients (n = 71) included in the study.
A New Imaging Technique for the Diagnosis of Thyroid Cancer: Thyroidography
Published in Journal of Investigative Surgery, 2021
Erhan Aysan, Ozan Aydin, Merve Ercivan, Direnc Aksoy, Alp Erdem Yavuz
A prospective clinical trial was planned with approval from the local human ethics committee. Written informed consent was obtained from the patients. 730 cases presented to Bezmialem Vakif University, Department of General Surgery, Division of Endocrine Surgery outpatient clinic between June 01, 2016 and December 01, 2016 with the diagnosis of any thyroid disease. Forty-five cases (37 women, 8 men, women/men: 4.6, age range: 17–68 years, mean age: 43 years) were included in the study. Inclusion criteria included: older than 17 years, patients with primary (non-recurrent) thyroid disease and patients planned for total thyroidectomy (not lobectomy or neck dissection). Exclusion criteria included: younger than 17 years, patients with recurrent or secondary thyroid disease and patients not planned for total thyroidectomy.
Investigation on EMG Profiles of the Superior Laryngeal Nerve in a In Vivo Porcine Model
Published in Journal of Investigative Surgery, 2020
Yishen Zhao, Changlin Li, Xiaoli Liu, Le Zhou, Daqi Zhang, Jingwei Xin, Tie Wang, Shijie Li, Hui Sun, Gianlorenzo Dionigi
Personnel involved were provided with the defined experimental, thyroidal and IONM procedures. They were trained for standardized IONM techniques, unusual IONM conditions, troubleshooting algorithms and for appropriately using IONM. The two senior authors (HS and GD) performed more than 5,000 monitored procedures in humans, and more than 50 experimental. IONM curriculum started in 2004 and 2008 per GD and HS, and continuous intraoperative neural monitoring (CIONM) modules commenced in 2011. An interest in endocrine surgery originated in 2000 (GD) and 1995 (HS). Since 2013 and 2008 respectively, both HS and GD academic settings were as national and international training centers for neural monitoring. IONM animal models for research and tutoring were held 2–3 times per year per center.