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• W3088171405 abstract "In the past thyroid surgery has been the most common cause of thyroid storm, but recently, preoperative drugs that create a euthyroid state before surgery have somewhat improved treatment outcomes. An active treatment approach in the perioperative period can determine the effective clinical treatment of this life-threatening disease. Therefore, the anesthesia of such operations is very important.The aim of this work: The aim of the study was to evaluate the use of dexmedetomidine as an intravenous adjuvant for general anesthesia for thyroidectomy in patients with manifestations of thyrotoxicosis.Materials and methods. The study was conducted at State Institution of Science “Research and Practical Centre of Preventive and Clinical Medicine” State Administrative Department, Kyiv, Ukraine. It was prospective, not randomized. The study involved 123 patients with thyrotoxicosis who underwent routine thyroidectomy under general anesthesia using sevoflurane (inhalation anesthetic) and fentanyl (narcotic analgesic) in low-flow artificial lung ventilation. Methods of perioperative monitoring (International Standards for a Safe Practice of Anesthesia 2010, WFSA) were supplemented using indirect calorimetry. The degree of preoperative risk of patients – ASA IІI-IV. Patients were divided into two groups. In the control group (I, n=64) during the operation was additionally administered intravenously esmolol hydrochloride at a heart rate ≥90 beats/min (the saturation dose was 500μg×kg-1×min-1 for 1-th minute and then – 25-50 μg×kg-1×min-1) under the control of the ECG and hemodynamic parameters before normalization of heart rate. In the main group (II, n=59) – intravenously dexmedetomidine (0,1 μg×kg-1×hr-1). At all stages of anesthesia, hemodynamic parameters, oxygen transport and metabolism were monitored, which was determined by indirect calorimetry. Blood cortisol levels were determined. The obtained information was processed using statistical packages MedStat v. 4. and Microsoft Office.Results and discussions. Baseline metabolic rates in both groups were quite high and were, respectively, 828±17 cal×min-1×m-2 in group I and 832±13 cal×min-1×m-2 in group II, which exceeded their Basal Metabolic Rate (BMR): in group I – by 54,5% and in group II – by 58,5% (p <0,01). At the stage of induction of anesthesia in group I revealed depression of the hemodynamic profile, probably associated with the effect of the introduction of esmolol hydrochloride, which led to a decrease in oxygen transport without metabolic disorders. At the stages of mobilization and removal of the thyroid gland, in both groups there were manifestations of hyperdynamics and hypermetabolism. At the same time, the metabolism in group II, at these stages, was lower by 9,3% and 10,1%, respectively, than in the control group (p <0,05). In both groups, there was an increase in blood cortisol levels, which, compared with baseline, reached maximum values at removal of the thyroid gland (19,12±1,49 μg/dl in the group I and 1,42±1,68 μg/dl in the group II), which indicates the corresponding activation of the adrenal system (p <0,05). In the group I at the stage of gland removal, wound suturing and awakening, the level of cortisol was higher than in the group II (p <0.05).Conclusions. The use of dexmedetomidine at a dose of 0,1 μg×kg-1×hour-1 in the scheme of anesthesia during thyroidectomy, suppresses the hemodynamic response caused by surgical stress, stabilizes oxygen consumption and maintains a stable metabolic rate. Carrying out perioperative energy monitoring with the use of indirect calorimetry during anesthesia allows to identify metabolic disorders and to carry out the appropriate pathogenetic correction." @default.
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• W3088171405 date "2020-09-01" @default.
• W3088171405 modified "2023-10-18" @default.
• W3088171405 title "EXPERIENCE OF DEXMEDETOMIDINE USE IN SURGERY IN PATIENTS WITH THYROTOXICOSIS" @default.
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• W3088171405 doi "https://doi.org/10.25284/2519-2078.3(92).2020.211474" @default.
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