Vera Sabljak

Risk factors for intraoperative hypotension during thyroid surgery

Background Hypotension is a common adverse effect of IV anaesthetics, especially during the induction of anaesthesia. The aim of our study was to determine the incidence and risk factors for intraoperative hypotension (IOH) in thyroid surgery, as well as to determine whether and to what extent IOH affects the occurrence of postoperative hypotension. Material/Methods The study included 1252 euthyroid patients, ASA 2 and ASA 3 status (American Society of Anesthesiologists physical status classification), who had thyroid surgery between 2007 and 2011. IOH was defined as a decrease in systolic blood pressure of >20% of baseline values. We studied the influence of demographic characteristics (sex, age, body mass index-BMI), comorbidity, type and duration of surgery, and anaesthesia on the occurrence of IOH. Univariate and multivariate logistic regression were used to determine predictors of occurrence of IOH. Results IOH was registered in 6.5% of patients. The most common operation was thyroidectomy. Patients with IOH were younger, had lower BMI, and significantly less often had hypertension as a coexisting disease. The multivariate regression model identified BMI and the absence of hypertension as a coexisting disease, and as independent predictors of occurrence of IOH. Significantly more patients with IOH had postoperative hypotension (9.9% vs. 2.4%, p=0.000). Conclusions IOH is common, even during operations of short duration and with minimal bleeding. It is necessary to pay special attention to these patients, given that many of these patients remained hypotensive during the postoperative period.

Anaesthesia and the patient with diabetes

AIMS To provide updated knowledge regarding the airway management and the possibility of difficult intubation in diabetic patients. MATERIALS AND METHODS We preformed a systematic literature review of the English language literature, published over the past 10 years which deals with this subject. RESULTS The vast majority of the modern literature data supports the fact that diabetic population has higher risk for difficult intubation occurrence. The most important characteristics of diabetic patients that are considered to be contributing factors for the difficult intubation are obesity, increased neck circumference and stiff joint syndrome. CONCLUSION A special attention and thorough preoperative preparation should be given to patients with diabetes. In order to predict and prevent difficult intubation in these patients, further studies are needed to investigate this issue closely.

Hyomental distance in the different head positions and hyomental distance ratio in predicting difficult intubation

The hyomental distance ratio (HMDR) is the ratio between the hyomental distance (HMD) (the distance between the hyoid bone and the tip of the chin) at the extreme of head extension (HMDe) and the one in the neutral position (HMDn). The objective of the study was to examine the predictive value, sensitivity, and specificity of HMDe, HMDn, and HMDR in predicting difficult endotracheal intubation (DI). A prospective study included 262 patients that underwent elective surgical operations. The following parameters were observed as possible predictors of DI: HMDR, HMDe, HMDn, Mallampati score, and body mass index (BMI). The cut-off points for the DI predictors were HMDe <5.3 cm, HMDn ≤5.5 cm, and HMDR ≤1.2. The assessment that DI existed was made by the anesthesiologist while performing laryngoscopy by applying the Cormack-Lehane classification. DI was present in 13 patients (5%). No significant difference was observed in the frequency of DI with regard to the sex, age, and BMI of the patients. Our research indicated HMDR as the best predictor of DI with a sensitivity of 95.6% and specificity of 69.2%. HMDR can be used in the everyday work of anesthesiologists because HMDR values ≤1.2 may reliably predict DI.The hyomental distance ratio (HMDR) is the ratio between the hyomental distance (HMD) (the distance between the hyoid bone and the tip of the chin) at the extreme of head extension (HMDe) and the one in the neutral position (HMDn). The objective of the study was to examine the predictive value, sensitivity, and specificity of HMDe, HMDn, and HMDR in predicting difficult endotracheal intubation (DI). A prospective study included 262 patients that underwent elective surgical operations. The following parameters were observed as possible predictors of DI: HMDR, HMDe, HMDn, Mallampati score, and body mass index (BMI). The cut-off points for the DI predictors were HMDe <5.3 cm, HMDn ≤5.5 cm, and HMDR ≤1.2. The assessment that DI existed was made by the anesthesiologist while performing laryngoscopy by applying the Cormack-Lehane classification. DI was present in 13 patients (5%). No significant difference was observed in the frequency of DI with regard to the sex, age, and BMI of the patients. Our research indicated HMDR as the best predictor of DI with a sensitivity of 95.6% and specificity of 69.2%. HMDR can be used in the everyday work of anesthesiologists because HMDR values ≤1.2 may reliably predict DI.

The Incidence of Intraoperative Hypertension and Risk Factors for its Development during Thyroid Surgery

We studied the influence of demographic characteristics, comorbidity, and type and duration of surgery and anesthesia on the occurrence of intraoperative hypertension (IOHTA). Logistic regression analyses were used in order to determine the predictors of occurrence of IOHTA. More than 60% of our patients had IOHTA. Multivariate analysis showed that independent predictors for IOHTA were older age, BMI 25 kg/m2, and hypertension as a coexisting disease. Hypertension is common during thyroid surgery, and a significant number of patients remained hypertensive during the postoperative period.

A rare case of anaplastic thyroid carcinoma in a young woman with prolonged survival

Anaplastic thyroid cancer (ATC) is one of the most aggressive tumors in human medicine. Despite the multimodal therapy, the average survival of patients is just several months. Fortunately, it is an extremely rare tumor. Most frequently, ATC occurs in the elderly, with the average age of the patients being almost 70 years. It is extremely rare that ATC occurs in people under the age of 40. We report a case of a 33 year old woman with ATC, with the diameter of the tumor being 8x7cm, confirmed by histopathology and imunohistochemistry. In January 2001, a total thyroidectomy was performed, and the tumor was completely resected. Postoperatively, the patient received radiation therapy. Ten years after the surgery, on regular check-ups, the patient is still living and there is no evidence of a recurrent tumor or metastases. This case is instructive for two reasons, as it shows that ATC can occur in younger people and that there is a possibility of long term survival.