DOCSLIB.ORG

17 Complications in Thyroid and Parathyroid Surgery

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
17 Complications in Thyroid and Parathyroid Surgery 217 17 Complications in Thyroid and Parathyroid Surgery Andrea Frilling and Frank Weber Contents Once death from thyroid operation became an exception, specific pitfalls of the procedure, namely, 17.1 Introduction . 217 injuries to the laryngeal nerves and damage to the 17.2 General Complications . 217 parathyroid glands, became obvious. While some sur- 17.3 General Surgical Complications . 218 geons, including Kocher, tried to prevent recurrent 17.3.1 Wound Infection . 218 laryngeal nerve injuries by avoiding any contact with 17.3.2 Edema . 218 the region of the nerve, others advocated routine iden- 17.3.3 Bleeding . 218 tification and dissection of the nerve. The importance 17.3.4 Malpositioning . 218 17.4 Specific Surgical Complications . 218 of the external branch of the superior laryngeal nerve 17.4.1 Unilateral Injury to the Recurrent was not appreciated until decades later. Halsted is Laryngeal Nerve . 218 credited for his studies of surgical anatomy and blood 17.4.2 Bilateral Recurrent supply of the parathyroid glands and the introduction Laryngeal Nerve Injury . 220 of the technique of capsular dissection that imple- 17.4.3 Injury to the Superior Laryngeal Nerve . 221 mented preservation of the vascular pedicle of a para- 17.4.4 Rare Neural, Vascular, thyroid gland and led to a safer approach to thyroid and Visceral Lesions . 221 and parathyroid surgery. Today morbidity remains a 17.4.5 Tracheal Instability . 222 subject of concern for surgeons performing thyroid 17.4.6 Injury to the Lymphatic Structures . 222 and parathyroid procedures. Injury of the recurrent 17.4.7 Hypoparathyroidism . 222 laryngeal nerve and hypoparathyroidism are the most 17.4.8 Thyroid Storm . 223 frequent complications. The key issue of an effective References . 223 and safe surgical approach is a profound knowledge of specific anatomy and pathophysiology in combina- tion with meticulous handling and dissection of tis- sue. The overall permanent complication rate should 17.1 Introduction not exceed 1% in centers providing expertise [2–4]. The relationship between volume of operations and Mortality from thyroid and parathyroid surgery is outcome has been extensively examined by Sosa et virtually disregarded nowadays. During the eigh- al. in the State of Maryland [2]. They demonstrated teenth century, however, the mortality rate of thyroid a significant inverse relationship between the volume surgery was as high as 40% from bleeding and sepsis of thyroidectomies performed by individual surgeons [1]. As a consequence, in 1850 the French Academy and complication rates, postoperative length of stay, of Medicine recommended its routine use be aban- and hospital charges. Surgeons who performed more doned, and many leading surgeons would not per- than 100 thyroidectomies over a 6-year period had form it. The greatest advance in thyroid surgery is to the lowest hospital charges, compared with those per- be credited to Theodor Kocher who first recognized forming 30–100 cases, 10–29 cases, and between one the importance of anti- and aseptic handling, hemo- and nine cases. stasis, and precise operative technique. Within a de- cade, his overall operative mortality decreased from 15% to 2.4%. With the exclusion of complicated cases, 17.2 General Complications in 1898 he reported a mortality rate of only 0.18%. Following Kocher’s principles, William Halsted, Endocrine neck surgery is associated with general Charles Mayo, George Crile, and others contributed non-surgical morbidity in less than 1.5% of patients, further to the development of thyroid surgery. corresponding to respiratory (1.5%), urologic (0.9%), 218 Andrea Frilling and Frank Weber gastrointestinal (0.8%), and cardiac (0.5%) complica- sels, can be performed prior to wound closure. Rou- tions. In addition, allergy, drug, or other abnormal tine use of suction drains does not prevent postopera- reactions are reported in 0.4% of patients [2]. tive cervical bleeding. In the majority of patients, symptomatic hemor- rhage occurs between 6 and 12 hours after the initial 17.3 General Surgical Complications operation. Since in approximately 20% of cases the onset of hematoma symptoms is reported beyond 17.3.1 Wound Infection 24 hours postoperatively, ambulatory surgery with a 4- to 8-hour observation period might harbor risk Wound infections, usually caused by Staphylococ- of delayed intervention [7]. Once recognized, the cus or Streptococcus species are considered to be rare wound should be deliberately reopened and the he- events, occurring in 0.3% [5] to 0.8% [2] of cases. matoma evacuated. In case of significant respiratory Antibiotic prophylaxis is recommended only in im- distress emergency bedside hematoma evacuation, if munocompromised patients or in those with val- necessary in combination with endotracheal intuba- vular cardiac disorders. While mild neck cellulitis tion, is required. The requirement for tracheotomy frequently regresses under conservative treatment, either in the emergency setting or due to persisting abscesses require rapid incision and evacuation. De- airway obstruction after hematoma removal is gener- lay of invasive treatment can result in devastating me- ally a rare event. diastinitis. Clinically evident seromas respond well to percutaneous aspiration. 17.3.4 Malpositioning 17.3.2 Edema The brachial plexus and ulnar nerve may be at risk when a patient is malpositioned on the operating Laryngotracheal edema can be a cause of respiratory table. In order to avoid nerve paralysis both arms obstruction after extensive thyroid surgery. After bi- should be adducted and secured. Hyperextension of lateral lymphadenectomy, disturbances of lymphatic the head causes nausea and headache during the early flow may be the cause of edema. Pharyngolaryngeal postoperative course. edema, in addition, is a well-recognized complication caused by the endotracheal tube or laryngeal mask and can also occur in association with an anaphy- 17.4 Specific Surgical Complications lactoid reaction [6]. Steroid therapy, occasionally in combination with temporary reintubation, leads to 17.4.1 Unilateral Injury to the Recurrent rapid relief. Laryngeal Nerve Recurrent laryngeal nerve (RLN) injury is one of the 17.3.3 Bleeding most serious complications in endocrine surgery. It is related to significant morbidity and frequent mal- The incidence of symptomatic hemorrhage requir- practice litigation [10]. The recurrent laryngeal nerve ing reintervention amounts to 0.1–1.5% [5–9]. Post- originates from the trunk of the vagus nerve. Upon operative bleeding will characteristically be prefaced reaching the larynx, it is renamed the inferior laryn- by respiratory distress, pain, or cervical pressure, geal nerve. It innervates all the intrinsic muscles of dysphagia, and increased blood drainage. No specific the same side with the exception of the cricothyroid perioperative risk factors that would allow identifica- muscles, and supplies sensory innervation to the la- tion of the high-risk patient population for this po- ryngeal mucosa below the true vocal folds. While as- tentially lethal complication are known. High surgical cending, the nerve on the right and on the left side volume does not reduce the incidence of hematoma delivers branches that supply the trachea and the formation. Consequently, the key issue of prevention esophagus. The morphologic appearance and course is attention to anatomic detail and careful hemosta- of the recurrent laryngeal nerve are subject to great sis during surgery. If the surgeon is uncertain about anatomic variability. In addition, it may often be over- the dryness of the operative field, a Valsalva maneu- looked that the nerve most frequently does not con- ver, which elevates the intrapulmonary pressure to sist only of a single trunk but exhibits a network of 40 cm H20 and facilitates recognition of bleeding ves- smaller branches. On the right side it usually loops 17 Complications in Thyroid and Parathyroid Surgery 219 around and behind the subclavian artery and then as- the posterior thyroid capsule near the cricoid cartilage cends into the neck in the tracheoesophageal groove and upper tracheal rings. In addition to visual identi- to enter the larynx distal to the inferior cornu of the fication, the nerve can be located by direct palpation thyroid cartilage. In instances of embryologic malfor- of the tracheal wall below the lower thyroid pole. mation of the aortic arch in terms of retroesophageal Considerable debate has long existed concerning the right subclavian artery, the nerve passes with a more necessity of deliberate exposure of the recurrent la- median course directly to the larynx (non-recurrent ryngeal nerve during thyroid surgery. Kocher com- laryngeal nerve) (Fig. 7.4). Although the reported in- mented on postoperative hoarseness and stated that, cidence of non-recurrent laryngeal nerve is less than following his technique of thyroid dissection, injury 1%, the surgeon has to be aware of the existence of to the nerve can with certainty be avoided without this rare anatomic condition [11,12]. The left recur- the direct exposure. The first surgeon who advocated rent laryngeal nerve courses upward around the liga- routine dissection and demonstration of the nerves in mentum arteriosum and the aortic arch and runs 1911 was August Bier of Berlin; he was followed by vertically toward the tracheoesophageal groove. On Frank Lahey of Boston in 1938 [13]. Others advocated their way to the cricothyroid muscle where they en- that exposure itself is a risk due to potential induction ter the larynx, both nerves run close to the capsule of local edema by dissection of adjacent tissues and of the lateral aspect of the thyroid and cross the infe- hemorrhage. Following these initial experiences, sev- rior thyroid artery. Several variations of the relation- eral studies revealed that depending upon the skill of ship between the nerve and the artery, particularly an individual surgeon principal identification of the on the right side, can be observed. The nerve may nerve reduces the risk of permanent laryngeal nerve pass superficially to the artery, deep to it, or between injuries from over 5% to less than 1% (Table 17.1) the branches of the vessel (Fig.
Load more

Recommended publications
  • Vocal Cord Dysfunction: a Review Neha M
    Dunn et al. Asthma Research and Practice (2015) 1:9 DOI 10.1186/s40733-015-0009-z REVIEW Open Access Vocal cord dysfunction: a review Neha M. Dunn1*, Rohit K. Katial2 and Flavia C. L. Hoyte2 Abstract Vocal cord dysfunction (VCD) is a term that refers to inappropriate adduction of the vocal cords during inhalation and sometimes exhalation. It is a functional disorder that serves as an important mimicker of asthma. Vocal cord dysfunction can be difficult to treat as the condition is often underappreciated and misdiagnosed in clinical practice. Recognition of vocal cord dysfunction in patients with asthma-type symptoms is essential since missing this diagnosis can be a barrier to adequately treating patients with uncontrolled respiratory symptoms. Although symptoms often mimic asthma, the two conditions have certain distinct clinical features and demonstrate specific findings on diagnostic studies, which can serve to differentiate the two conditions. Moreover, management of vocal cord dysfunction should be directed at minimizing known triggers and initiating speech therapy, thereby minimizing use of unnecessary asthma medications. This review article describes key clinical features, important physical exam findings and commonly reported triggers in patients with vocal cord dysfunction. Additionally, this article discusses useful diagnostic studies to identify patients with vocal cord dysfunction and current management options for such patients. Keywords: Vocal cord dysfunction, Paradoxical vocal fold movement, Vocal cord, Asthma-comorbidity Introduction medical literature 70 years later, in 1974, by Patterson Vocal cord dysfunction (VCD) is a term that refers to in- and colleagues in a 33 year old woman with 15 hospitali- appropriate adduction of the vocal cords during inhalation zations for what they termed “Munchausen’s stridor” [6].
    [Show full text]
  • The Importance of Inspiratory Maneuver for Benign Laryngeal Lesions
    THIEME Original Research 513 The Importance of Inspiratory Maneuver for Benign Laryngeal Lesions Marília Batista Costa1 Taynara Oliveira Ledo1 Mariana Delgado Fernandes1 Romualdo Suzano Louzeiro Tiago1 1 Otorhinolaryngology Department, Hospital do Servidor Publico Address for correspondence Marília Batista Costa, MD, Estadual de Sao Paulo, Sao Paulo, SP, Brazil Otorrinolaringologia, Hospital do Servidor Publico Estadual de São Paulo, Rua Pedro de Toledo, 1800, Vila Clementino, São Paulo, SP, Int Arch Otorhinolaryngol 2020;24(4):e513–e517. 04029-000, Brazil (e-mail: [email protected]). Abstract Introduction Inspiratory maneuver corresponds to a simple method used during videolaryngoscopy to increase characterizations of laryngeal findings, through the movement of the vocal fold cover and exposure of the ligament, facilitating its evaluation. Objective To evaluate the increase in diagnosis of benign laryngeal lesions from the usage of inspiratory maneuvers during videolaryngoscopy in patients with or without vocal complaints. Methods A cross-sectional study performed from March 1 to July 1, 2018, in the Laryngology sector of a tertiary hospital. The age of the patients varied from 18 to 60 years old. They were divided into two groups, symptomatic and asymptomatic vocals, and evaluated through videolaryngoscopy together with inspiratory maneu- vers. The exams were recorded and later evaluated by three trained laryngologists who determined the laryngeal lesions before and after the inspiratory maneuver. Results Therewere60patientsinthissample,41ofwhichwerevocalsymptomatic and 19 asymptomatic. The majority was female and the main complaint was about dysphonia. Before the inspiratory maneuver, the most observed lesions in both groups were chronic laryngitis, followed by vascular dysgenesis. After the inspiratory maneu- Keywords ver, sulcus vocalis was the most frequent additional finding.
    [Show full text]
  • Benign Thyroid Disease and Vocal Cord Palsy
    Annals of the Royal College ofSurgeons of England (1993) vol. 75, 241-244 Benign thyroid disease and vocal cord palsy Julian M Rowe-Jones MB FRCS Susanna E J Leighton MB FRCS Registrar in Otolaryngology Senior Registrar in Otolaryngology R Paul Rosswick MS FRCS Consultant General Surgeon St George's Hospital and Medical School, London Key words: Multinodular goitre; Thyroid adenoma; Graves' disease; Hashimoto's thyroiditis; Vocal cord palsy The case notes of 2453 consecutive patients admitted for intrinsic laryngeal muscles including cricothyroid, there- thyroid surgery and with successful preoperative laryngo- by suggesting vagal or concurrent superior and recur- scopy were examined retrospectively. Of the 2408 patients rent laryngeal nerve involvement (1). who had not had previous operations on the gland, 2321 proved to have benign pathology. A total of 29 patients had a preoperative vocal cord palsy of which 22 were associated Materials and methods with benign disease. Return of cord movement after surgery occurred in 89% of the patients with a benign goitre. We advocate routine preoperative laryngoscopy to detect vocal The case records of 2453 consecutive patients undergoing cord paresis. Such a finding with a goitre does not necessar- thyroid surgery between 1947 and 1992, who had had ily indicate malignancy. The recurrent laryngeal nerve successful preoperative laryngoscopy, were analysed should therefore be identified at surgery and preserved to retrospectively. Laryngoscopy had been performed allow for recovery of vocal cord movement. indirectly using a mirror, or in the last 11 years with a flexible, fibreoptic nasendoscope when mirror examin- ation had been unsuccessful. The patients all had their vocal cord assessments performed by a registrar, senior Goitre with hoarseness is usually considered a portent of registrar or consultant.
    [Show full text]
  • A Cause of Acute Stridor T Jaiganesh, a Bentley
    666 CASE REPORTS Emerg Med J: first published as 10.1136/emj.2003.009886 on 19 August 2005. Downloaded from Hereditary motor and sensor neuropathy: a cause of acute stridor T Jaiganesh, A Bentley ............................................................................................................................... Emerg Med J 2005;22:666–667. doi: 10.1136/emj.2003.009886 We present an acute stridor secondary to bilateral vocal cord Table 1 Clinical presentation of HMSN related to the paresis in a patient with demyelinating form (type I) of genetic defects hereditary motor and sensory neuropathy (HMSN). Management problems are discussed and HMSN reviewed. Age of Chromo- onset (in Early Tendon Type some years) symptoms reflexes HMSN 1: dominant; demyelinating 1 A 17 5–10 Distal Absent 48 year old female attended the emergency department weakness with complaints of cough, breathing difficulty, and 1 B 1 5–10 Distal Absent Aflu-like symptoms for one day. She suffers from weakness hereditary motor and sensory neuropathy (HMSN) Type Ia, 1 C Unknown 10–15 Distal Reduced weakness which had been detected by isolating DNA from a blood 1D 10 10–15 Distal Absent sample for the presence of duplication on Chromosome 17. weakness She had been treated for asthma for two years and had X X 10–15 Distal Absent a history of nocturnal choking episodes. Examination weakness HMSN 2: dominant; revealed inspiratory stridor with indrawing of neck axonal muscles. The ear, nose, and throat (ENT) surgeons, con- 2 A 1 10 Distal Absent sultant anaesthetist, and intensivist were contacted. ENT weakness examination through a fibre optic flexible laryngoscope 2 B 3 10–20 Distal Absent weakness revealed smooth white paramedian position of the vocal Sensory loss cords, which were not swollen.
    [Show full text]
  • Transient Bilateral Vocal Cord Paralysis After Endotracheal Intubation with Double-Lumen Tube -A Case Report
    Korean J Anesthesiol 2010 December 59(Suppl): S9-S12 Case Report DOI: 10.4097/kjae.2010.59.S.S9 Transient bilateral vocal cord paralysis after endotracheal intubation with double-lumen tube -A case report- Dae Myoung Jeong1, Gunn Hee Kim2, Jie Ae Kim1, and Sangmin Maria Lee1 Department of Anesthesiology and Pain Medicine, 1Samsung Medical Center, Sungkyunkwan University School of Medicine, 2National Medical Center, Seoul, Korea Vocal cord paralysis is one of the most serious anesthetic complications related to endotracheal intubation. The practitioner should take extreme care, as bilateral vocal cord paralysis can obstruct the airway and lead to disastrous respiratory problems. There have been many papers on bilateral vocal cord paralysis after neck surgery, but reports on such a condition after lung surgery are very rare. We report a case of bilateral vocal cord paralysis detected after removal of a double-lumen endotracheal tube in a 67-year-old patient who underwent wedge resection by video- assisted thoracoscopic surgery. We also note that he recovered spontaneously without complications within a day. (Korean J Anesthesiol 2010; 59: S9-S12) Key Words: Bilateral vocal cord paralysis, Double-lumen endotracheal tube, Postoperative stridor. Bilateral vocal cord paralysis is widely known to be a com- Case Report plication of general anesthesia [1,2]. There have been few reports, however, of bilateral vocal cord paralysis related to a A 67-year-old man, 164.5 cm in height and 64.7 kg in weight, double-lumen endotracheal tube (DLT) [3]. was admitted to the hospital for investigation of abnormal We encountered a patient with bilateral vocal cord paralysis, shadows on chest X-ray in both lungs.
    [Show full text]
  • Laryngeal Evaluation During the COVID-19 Pandemic: Transcervical Laryngeal Ultrasonography
    Complete ManuscriptClick here to access/download;Complete Manuscript;Laryngeal Evaluation During the COVID19 Pandemic - FINAL.docx This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. 1 Laryngeal Evaluation During the COVID-19 Pandemic: Transcervical Laryngeal Ultrasonography Julia E. Noel, MD1; Lisa A. Orloff, MD1; Kwang Sung, MD, MS1 1Department of Otolaryngology Head & Neck Surgery Stanford University School of Medicine Stanford, CA 94305 Funding: None Conflicts of Interest: None Author Roles: Noel: Manuscript design/organization, drafting and revisions, figure editing, final approval Orloff: Manuscript conception, manuscript drafting, figure acquisition, final approval Sung: Manuscript conception, manuscript drafting and revisions, final approval Corresponding Author: Julia E. Noel, MD Department of Otolaryngology Head & Neck Surgery Stanford University School of Medicine 875 Blake Wilbur Drive Stanford, CA 94305 Phone: 650-498-6000 Fax: 650-724-1445 Email: [email protected] Keywords: Coronavirus, COVID-19, vocal cord paralysis, vocal cord paresis, laryngeal evaluation, laryngeal ultrasound This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. 2 Abstract: The novel coronavirus disease (COVID-19), caused by the SARS-CoV-2 virus, has quickly escalated to become a global pandemic since its initial outbreak in China in late 2019. Institutions are faced with the challenge of providing the standard of care while maintaining safety for healthcare personnel and patients. Due to the common performance of aerosol generating endoscopic procedures in the upper respiratory tract, otolaryngologists are at uniquely high risk for potential infection. When possible, alternative diagnostic and treatment strategies should be pursued.
    [Show full text]
  • Laryngeal Injury in the Intubated ICU Patient
    Laryngeal Injury in the Intubated ICU Patient A Senior Honors Thesis Presented in Partial Fulfillment of the Requirements for graduation with research distinction in Speech and Hearing Science in the undergraduate colleges of The Ohio State University by Arnold Olszewski, Jr. The Ohio State University May 2008 Project Advisor: Michael Trudeau, Ph.D., Department of Speech and Hearing Sciences Olszewski 2 Acknowledgements I would like to acknowledge my advisor, Michael Trudeau, Ph.D. for his generous amount of support and guidance in conducting this thesis. I would also like to acknowledge Jan Weisenberger, Ph.D. for sparking my interest in research and for introducing me to such a great advisor. Lastly, I would like to acknowledge Brad deSilva, M.D. for allowing me to be a part of his study and for sharing his data with me so that I could form my own thesis with the help of his efforts. I appreciate all of your assistance and couldn’t have done this without you. Olszewski 3 Table of Contents I. Abstract p. 4 II. Introduction p. 5-6 III. Literature Review p. 7-11 IV. Methods p. 12-13 V. Results p. 14-16 VI. Discussion p. 17-19 VII. References p. 20 Appendix 1 (Data Table) p. 21-25 Appendix 2 (Patient Consent Form) p. 26-30 Appendix 3 (Sample Data Collection Sheet) p. 31 Olszewski 4 I. Abstract Endotracheal intubation is a regularly used life-saving process for patients brought into hospital emergency rooms. Previous research has indicated that up to 94% of patients who have undergone the endotracheal intubation procedure have sustained laryngeal injuries post extubation (Santos, 1994).
    [Show full text]
  • Incidence of Vocal Cord Paralysis with and Without Recurrent Laryngeal Nerve Monitoring During Thyroidectomy
    ORIGINAL ARTICLE Incidence of Vocal Cord Paralysis With and Without Recurrent Laryngeal Nerve Monitoring During Thyroidectomy Maisie Shindo, MD; Neil N. Chheda, MD Objective: To compare the incidence of postoperative Results: The incidence of unexpected unilateral vocal vocal cord paresis or paralysis in a cohort of patients who cord paresis based on RLNs at risk was 2.09% (n=14) in underwent thyroidectomy with and without continu- the monitored group and 2.96% (n=11) in the unmoni- ous recurrent laryngeal nerve (RLN) monitoring by a tored group. This difference was not statistically signifi- single senior surgeon. We hypothesize that continuous cant. The incidence of unexpected complete unilateral RLN monitoring reduces the rate of nerve injury during vocal cord paralysis was 1.6% in each group. Two of the thyroidectomy 5 paralyses in the unmonitored group and 7 of the 11 paralyses in the monitored group had complete resolu- Design: Retrospective medical chart review. tion. Setting: Academic tertiary care medical center. Conclusions: Monitoring of the RLN does not appear to reduce the incidence of postoperative temporary or per- Patients: A total of 684 patients (1043 nerves at risk) who manent complete vocal cord paralysis. There appeared underwent thyroid surgery under general anesthesia. to be a slightly lower rate of postoperative paresis with RLN monitoring, but this difference was not statisti- Main Outcome Measure: Incidence of vocal cord pa- cally significant. resis or paralysis in patients who underwent thyroid sur- gery with continuous RLN monitoring vs those under- going surgery without continuous RLN monitoring. Arch Otolaryngol Head Neck Surg. 2007;133:481-485 NJURY OF THE RECURRENT LARYN- tended stretch may be reduced by early geal nerve (RLN) is fortunately no warning signals and that the nerve posi- longer a very common compli- tion can be confirmed by direct stimula- cation of thyroid surgery.
    [Show full text]
  • General Thoracic Surgery Database Training Manual Version 2.41
    SEPTEMBER 4, 2020 Data Manager Quick Links New Data Warehouse - Starting January 1, 2020 – Important Information for ALL SITES! Database Transition Resources STS National Database Webinars Data Manager Education Data Collection Resources (version specific abstraction documents) Ask an Abstraction Question STS National Database News - Publication for STS Data Managers Public Reporting Contact Information GENERAL THORACIC SURGERY DATABASE TRAINING MANUAL VERSION 2.41 General Thoracic Surgery Database V2.41 Training Manual September 4, 2020 Table of Contents Case Examples ............................................................................................................................................................3 Definitions ..................................................................................................................................................................4 Risk Model ..................................................................................................................................................................4 Demographics .............................................................................................................................................................5 Admission ................................................................................................................................................................ 13 Pre-Operative Evaluation .......................................................................................................................................
    [Show full text]
  • S Edema of Vocal Cords Driven by Rewarding the Competent with a Greater Share of Society’S Fruits
    CORRESPONDENCE 775 barotrauma. Modern anesthetic ventilators such as the contractual obligations, tribal/religious identification, Datex-Ohmeda S/5™ ADU with tidal volume com- or xenophobia, has mixed results, often because limit- pensation adjusts the volume delivered by the ventila- ed opportunity, human rights or security supervene. tor bellow to ensure that the sum of the volume The desire of successful individuals to emigrate, like delivered from the ventilator and from the fresh gas the developmental failure of some resource rich coun- flow equals the preset tidal volume.2 tries (e.g., Zimbabwe and Zaire), has political roots. During each inspiratory phase of respiratory cycle No social or economic policy will effect meaningful (2.5 sec), the amount of tidal volume delivered was change without fixing the base cause. However, can equal to fresh gas flow/sec (13000 mL·60 sec–1) × 2.5 Canadians avoid exacerbating the problem? sec = 541 mL. This amount exceeded the preset tidal Firstly, our foreign policy should promote develop- volume of 500 mL. Therefore, there was no addition- ment of just and law abiding societies with transparent al delivery required from the ventilator bellows to economies. Secondly, Canadian health manpower pol- achieve the preset tidal volume. icy should not rely on migration from developing Anesthesiologists should be alerted to this phe- nations to supply our needs, as is currently the case. nomenon of ventilator bellow standstill during emer- Strangely, we deny our own children appropriate gence when the inspiratory volume delivered using a opportunities to become (expensively) educated pro- high fresh gas flow is greater than or equal to the pre- fessionals while promulgating, as one response to set tidal volume on volume control ventilation.
    [Show full text]
  • Evaluation of Outcomes After Reoperative Neck Dissection Due to Thyroid Cancer 269
    Original paper Aim of the study was to assess the re- sults of surgical treatment of cervical recurrences in patients with thyroid cancer. Evaluation of outcomes after Material and methods: We assessed 66 reoperations of thyroid cancer re- reoperative neck dissection due currences in 51 patients. Reoperative surgeries covered I–VII neck levels. to thyroid cancer Results and conclusions: The localiza- tion of cervical recurrence and the num- ber of removed nodes did not depend on the type of thyroid cancer. Metastatic spread was predominantly observed in 1 1 the central neck. Bilateral changes tend- Małgorzata Wierzbicka , Elżbieta Waśniewska-Okupniak , 1 1 2 ed to be observed more often in young- Jacek Banaszewski , Maciej Pabiszczak , Tomasz Piorunek er patients (p = 0.07). Radical neck dis- sections were performed more often at 1Department of Otorhinolaryngology, Head and Neck Surgery, Poznan University younger age (p < 0.01). Postoperative of Medical Sciences, Poznan, Poland vocal cord paresis was noted in 13 pa- 2Department of Pulmonology, Alergology and Respiratory Oncology, Poznan University tients; in 5 permanent tracheotomy was of Medical Sciences, Poznan, Poland necessary, and 2 underwent laser glot- tis procedures (posterior cordectomies). Two patients died in the postoperative period – 1 due to chylothorax and 1 due Introduction to severe bleeding from the common carotid artery. Increased mortality in patients with thyroid cancer (TC) due to regional lymph node metastases has been previously well described [1, 2]. The ne- Key words: thyroid cancer, neck dis- cessity of prophylactic neck dissection and the extent of therapeutic neck section. dissection in this population still remain an unresolved issue [3, 4].
    [Show full text]
  • Vocal Cord Palsy As a Complication of Epidural Anaesthesia
    Hindawi Case Reports in Otolaryngology Volume 2018, Article ID 6543656, 3 pages https://doi.org/10.1155/2018/6543656 Case Report Vocal Cord Palsy as a Complication of Epidural Anaesthesia Laura Mc Loughlin and Orla Young Department of Otorhinolaryngology Head & Neck Surgery, Galway University Hospital, Galway, Ireland Correspondence should be addressed to Laura Mc Loughlin; [email protected] Received 8 July 2018; Revised 1 October 2018; Accepted 14 October 2018; Published 25 October 2018 Academic Editor: Rong-San Jiang Copyright © 2018 Laura Mc Loughlin and Orla Young. )is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Cranial nerve palsy is a rare but recognised complication of epidural anaesthesia, most commonly presenting as diplopia secondary to abducens nerve palsy. While upper cranial nerve palsies have been documented on numerous occasions, lower cranial nerve palsies, including recurrent laryngeal nerve palsy, are exceedingly rare. )is case describes a 37-year-old female who, following epidural anaesthesia for spontaneous vaginal delivery of her first child, presented with dysphonia. Flexible laryngoscopy confirmed a left vocal cord palsy, and computed tomography ruled out any mass lesions along the course of the recurrent laryngeal nerve. Here, we discuss a case of vocal cord palsy secondary to epidural anaesthesia, an extremely rare complication. We also discuss the proposed etiology, treatment, and outcomes in patients with this condition. Cranial nerve palsy should be an important differential in patients presenting with dysphonia following spinal or epidural anaesthesia. 1. Introduction only for a recent diagnosis of mild hemochromatosis, and she was on no regular medication.
    [Show full text]