Clopidogrel discontinuation is associated with a 5% risk of ischemic events in patients treated with stent techniques. Any stroke related to clopidogrel discontinuation is avoidable, and longer treatment is therefore clearly necessary. Patients with cardiovascular risk factors, high-risk aneurysm features, and those undergoing stent-in-stent flow diversion might benefit the most from longer clopidogrel therapy.

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INTRODUCTIONThyroidectomies are one of the most common elective surgical procedures worldwide.1 Unlike other surgical interventions, where the incidence of postoperative nausea and vomiting is less than 30%, after thyroidectomy the incidence of postoperative nausea and vomiting (PONV) is 70% to 80% when no prophylactic antiemetic therapy is given.2-5 PONV is not only uncomfortable for the patient but repeated or vigorous vomiting can lead to postoperative bleeding with subsequent airway obstruction and potential reparative surgery. 6 The importance of avoiding PONV events was substantiated by the work of Apfel et al who found in preoperative interviews that patients were more afraid of PONV than postoperative pain. 7The exact mechanism of thyroidectomy-related nausea and vomiting is not clearly understood. It is assumed that significant edema and inflammation around the neck tissues may persistently evoke parasympathetic impulses through the vagus, recurrent laryngeal, and ABSTRACT Background: On thyroidectomy, incidence of postoperative nausea and vomiting, severe pain with local inflammation and voice impairment was very common. These effects can be manipulated by the use of steroids. Hence the present study, was conducted with the objective to evaluate the effects of a single preoperative dose of dexamethasone on thyroidectomy in terms of postoperative nausea and vomiting (PONV), pain and voice improvement. Methods: The present study was conducted between October 2010 and March 2011 at the Department of General Surgery, Government Medical College, Kottayam, Kerala, India. A total of 72 patients were included in the study after meeting requirements of inclusion criteria. They were divided into two groups. 37 were under Group C and received normal saline and remaining 35 served as Group D and received 8 mg/2 mL of dexamethasone preoperatively. Post-operative incidences of nausea and vomiting, pain scores, and the improvement of vocal function were compared in both groups. Results: Out of 72 patients, most of the patients participated were under the age group of 40-50 years (30.6%). Of them 9 were males and 63 were females. The incidence and severity of PONV and pain was significantly reduced in Group D compared to Group C with P values of 0.001 and 0.056 respectively. Significant protection of dexamethasone towards vocal function was not observed in the study (p =0.245). Conclusions: From the results obtained in the study, it was concluded that preoperative single dose administration of dexamethasone seemed to be safe in healthy patients undergoing thyroidectomy.

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Background: Hypocalcemia is one of the most common complications of thyroidectomy. Hence, parathyroid hormone (PTH) measurement can be used to predict patients at risk for developing significant postoperative hypocalcaemia after thyroidectomy. The present study was conducted with the objective to find out whether there is any correlation between intact PTH value and patients developing symptoms of hypocalcemia after total thyroidectomy and to determine the threshold value of 1 hour post total thyroidectomy (intact PTH level) that can identify those at high risk for developing symptomatic hypocalcemia.Methods: Study involved determination of serum calcium, creatinine and albumin preoperatively, serum intact PTH, 1 hour after completion of total thyroidectomy (i.e. after the closure of skin incision), and serum calcium levels 6, 24 and 48 hours postoperatively. Clinical findings suggestive of hypocalcaemia were also watched for and recorded. Symptomatic signs and/or symptoms were recorded. The patients were followed up for 3 days post operatively and the lowest recorded serum calcium was taken into account. The results were tabulated and entered in Microsoft excel and analysed with spss 17 statistical software.Results: 26% of the study population developed hypocalcemia. Intact PTH was found to be lower in patients who developed symptoms of hypocalcemia. There was a statisticantly significant correlation between the two groups. A one-hour Intact PTH value of 14 pg/ml was found to have high sensitivity (92.3%) and specificity (91.9%).Conclusions: Hypocalcemia is the most common complication after total thyroidectomy. Intact PTH measurement one hour after total thyroidectomy can be used to predict the patients who will develop hypocalcemia after total thyroidectomy. Therefore, patients having low one-hour intact PTH value could be started on calcium supplementation and those having high PTH could be safely discharged early.