The staggering hypothyroidism in head-and-neck cancer patients after combined multimodality treatment: Dealing with the anesthetic dilemma

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL
Bindu K. Vasu, S. Rajan, N. Sasikumar, S. Babu, Manu Sudevan, J. Paul
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Abstract

Background and Aims: Hypothyroidism is common following treatment of head-and-neck malignancy. We aimed to assess the incidence of hypothyroidism in patients posted for operations with a history of radical neck surgeries with or without adjuvant chemoradiotherapy, their requirement of induction agents, hemodynamic changes, and recovery time following general anesthesia. Methods: This was a prospective, nonrandomized single-arm study conducted in 100 patients aged 18–85 years, who were posted for surgery under general anesthesia after 3 months of radical neck surgery with or without adjuvant therapy. All patients received a standardized general anesthesia protocol. Patients were grouped into those having either hypothyroidism or those in the euthyroid state. Results: Seventy-two percent of patients had varying degrees of hypothyroidism. There was significant reduction in heart rate (HR) and mean arterial pressure (MAP) from preinduction values at 1, 3, 5, and 10 min after intubation in patients with hypothyroidism. The reduction in both HR and MAP was significantly pronounced throughout postintubation period in the hypothyroid patients as compared to the patients with normal thyroid function. The mean induction dose of propofol was significantly lesser for hypothyroid patients compared with euthyroid (0.85 ± 0.17 mg/kg vs. 1.62 ± 2.52 mg/kg), with prolonged recovery time. The incidence of hypotension was significantly high among the hypothyroid patients. Conclusion: The incidence of hypothyroidism in patients after radical neck surgery with or without adjuvant chemo-radiotherapy is as high as 72%. These patients required less anesthetic agents for the induction of general anesthesia and developed profound hypotension after induction which persisted after intubation and had a prolonged recovery time.
癌症头颈部患者多模式联合治疗后甲状腺功能减退的惊人表现:应对麻醉困境
背景与目的:甲状腺功能减退是头颈部恶性肿瘤治疗后的常见症状。我们的目的是评估有根治性颈部手术史的患者甲状腺功能减退的发生率,是否有辅助放化疗,他们对诱导剂的需求,血流动力学的变化,以及全身麻醉后的恢复时间。方法:这是一项前瞻性、非随机单臂研究,对100例年龄在18-85岁的患者进行了研究,这些患者在接受或不接受辅助治疗的根治性颈部手术3个月后,在全身麻醉下进行手术。所有患者均接受标准化全身麻醉方案。患者被分为甲状腺功能减退和甲状腺功能正常两组。结果:72%的患者有不同程度的甲状腺功能减退。甲状腺功能减退患者插管后1、3、5和10分钟的心率(HR)和平均动脉压(MAP)较诱导前显著降低。与甲状腺功能正常的患者相比,甲状腺功能减退患者的HR和MAP在整个插管后期间均显著降低。甲状腺功能减退患者异丙酚的平均诱导剂量(0.85±0.17 mg/kg vs. 1.62±2.52 mg/kg)明显低于正常甲状腺功能减退患者,且恢复时间延长。甲状腺功能减退患者低血压发生率明显增高。结论:根治性颈部手术后伴或不伴放化疗患者甲状腺功能减退的发生率高达72%。这些患者在全麻诱导时所需麻醉剂较少,诱导后出现深度低血压,插管后持续存在,恢复时间较长。
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来源期刊
Journal of Head & Neck Physicians and Surgeons
Journal of Head & Neck Physicians and Surgeons MEDICINE, GENERAL & INTERNAL-
CiteScore
0.30
自引率
0.00%
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0
审稿时长
15 weeks
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