Thyroidectomy

BACKGROUND: Among patients with well differentiated papillary thyroid carcinoma who generally have an excellent prognosis and a near-normal lifespan, there exist subsets of patients who have significant risk for morbidity and mortality from this disease. It is important to define the patterns of disease progression and the clinical outcome of such patients to develop effective surveillance and treatment strategies.

Between April 1994 and March 1996, 108 thyroidectomies (97 partial or unilateral lobectomies and 11 bilateral lobectomies) and 13 cervical explorations for hyperparathyroidism were performed under hypnosedation (HS) technique combining hypnosis and light conscious sedation. Informed consent was obtained from each patient. None of these patients underwent preoperatively standard susceptibility test score or preparatory hypnotic session. Nevertheless, no patient required conversion to general anesthesia.

Between April 1994 and June 1997, 197 thyroidectomies and 21 cervical explorations for hyperparathyroidism were performed under hypnosedation (HYP) and compared to the operative data and postoperative courses of a closely-matched population (n = 121) of patients operated on under general anaesthesia (GA). Conversion from hypnosis to GA was needed in two cases (1%). All surgeons reported better operating conditions for cervicotomy using HYP.

OBJECTIVES: To assess the feasibility of endocrine cervical surgery under hypnoanesthesia as a valuable, safe, efficient, and economic alternative to general anesthesia. METHODS: Between April 1994 and June 1997, 197 thyroidectomies and 21 cervical explorations for hyperparathyroidism were performed under hypnoanesthesia (HYP) using Erikson's method.

Since 1992, we have used hypnosis routinely in more than 1400 procedures in plastic surgery. Our clinical success and experience with this technique led us to test wether hypnosis using active patient collaboration, could be used as an effective adjunct to conscious intravenous sedation ("hypnosedation", (HS)) for endocrine surgery, as an alternative to general anaesthesia. On a total of 1905 cervical endocrine surgical procedures performed between 1995 and 1998, 296 thyroidectomies and 33 cervical explorations for hyperparathyroidism were conducted under HS.

BACKGROUND: Although telemedicine is one of the key initiatives of the World Health Organization, no study has explored the feasibility and efficacy of teleanaesthesia. This bi-centre pilot study investigates the feasibility of transcontinental anaesthesia. METHODS: Twenty patients aged ? 18 yr undergoing elective thyroid surgery for ? 30 min were enrolled in this study. The remote and local set-up was composed of a master-computer (Montreal) and a slave-computer (Pisa). Standard Internet connection, remote desktop control, and video conference software were used.

OBJECTIVE: To determine bispectral index (BIS) values produced by equipotent concentrations of commonly used volatile anaesthetics. METHODS: Female patients undergoing thyroidectomy were randomly assigned to receive isoflurane, sevoflurane or desflurane anaesthesia. After induction, anaesthesia was maintained by the volatile agent at 1 minimum alveolar concentration and supplemented with remifentanil infusion. BIS values were recorded during 1?h surgical anaesthesia after a 15?min equilibrium phase.

STUDY OBJECTIVE: To investigate whether the type of anesthetic agent administered affects the antitussive effect of remifentanil. DESIGN: Prospective randomized study. SETTING: Operating room of a university hospital. PATIENTS: 78 ASA physical status 1 and 2 women, aged 20 to 65 years, who were scheduled to undergo a thyroidectomy. INTERVENTIONS: Patients were randomly assigned to three groups to receive anesthesia with propofol (Group P), sevoflurane (Group S), or desflurane (Group D). The main anesthetics were titrated to maintain a target Bispectral Index for hypnosis of 40 to 60.