Endocrine Abstracts

Objectives.

A prospective study to analyze anesthetic risks and anesthesia particularities in thyrotoxicosis syndrome (TTS) patients who were undergone thyroidectomy.

Materials.

It was analyzed 880 operated the TTS patients. Surgical interventions were performed under general anesthesia with mechanical ventilation by using the inhalation anesthesia (IA) with sevoflurane in 698 (79.3%) patients, by the total intravenous anesthesia (TIVA) with propofol in 182 (20.7%) cases. We assessed the physical status on the American Association of Anaesthesiologists (ASA) classification, the frequency of concomitant pathology, the anesthesia particularities of the according to anesthesiologist’s recording reports.

Results

Among TTS patients, the 596 (68%) patients had diffuse toxic goiter (DTG), 208 (23%) patients had a multinodular goiter (MNG) with TTS, the rest of patient were with toxic adenoma - 44 (5%), 24 (3%) patients were with relapse of previously operated DTG or MNG. In 8 (1%) cases there was a combined pathology - papillary cancer in the background of MNG with TTS. The average age had a significant difference (p <0.01) by Wilcoxon test between the groups DTG and MNG and was 42.1 ± 1.6 and 52.8 ± 1.7 years, respectively. According to ASA only 210 patients (23.9%) had - ASA I. 76.1% out of 880 TTS patients had ASA II–IV class. 21.1% of patients were at high risk ASA III and IV. It was analyzed that the anesthesiologists performed systemic haemodynamic and cardiac rhythm correction by administering antihypertensive, antiarrhythmic, sympathomimetic drugs in 404 (45.9%) cases, of which 320 (45.8%) – IA with sevoflurane, 84 (46.2%) – with TIVA with propofol (P = 0.551, no statistically significant difference). Bradycardia appeared in 9.5% and 2.2% of cases of IA and TIVA respectively (P < 0.05). Perioperative hypertension, which required medication, arose in 26.1% of cases and 25.3% with IA and TIVA respectively (P > 0.05). The most commonly observed concomitant diseases in patients with DTG were dismetabolic cardiomyopathy – 55.0%, and the patients with MNG with thyrotoxicosis had arterial – 64.3%. No fatal case was observed.

Conclusions

TTS impairs the ASA physical status. There was 76.1% of patients with thyrotoxicosis, who had one or more concomitant pathologies - ASA II-IV class. 21.1% of the patients had ASA III and IV. Abnormal anesthesia were noted in 404 (45.9%) cases, that means than the personified approach to the choice of type of anesthesia is needed.