Sugammadex provides safer extubation with a shorter recovery time than neostigmine in pediatric patients undergoing outpatient surgical procedures.

Fentanyl provides better operative conditions and reduces the need for additional propofol doses. These advantages cause a shorter recovery time. Therefore, propofol-fentanyl is superior to the propofol-alfentanil for sedation-analgesia in colonoscopy.

Background/Aims: Different drug combinations are used for sedation in colonoscopy procedures. A ketaminepropofol (ketofol) mixture provides effective sedation and has minimal adverse effects. Alfentanil also provides anesthesia for short surgical procedures by incremental injection as an adjunct. However, no study has investigated the use of ketofol compared with an opioid-propofol combination in colonoscopic procedures. Materials and Methods: A total of 70 patients, ASA physical status I-II, scheduled to undergo elective colonoscopy, were enrolled in this prospective randomized study and allocated to two groups. After premedication, sedation induction was performed with 0.5 mg/kg ketamine +1 mg/kg propofol in Group KP, and 10 mg/kg alfentanil +1 mg/kg propofol in Group AP. Propofol was added when required. Demographic data, colonoscopy duration, recovery time, discharge time, mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation, Ramsey Sedation Scale values, colonoscopy patients' satisfaction scores, and complications were recorded. Results: The need for additional propofol doses was significantly higher in Group AP than in Group KP. MAP at minute 1 and 5, Ramsey Sedation Scale at minute 5, and discharge time were significantly higher in Group KP than in Group AP. Additional propofol doses and total propofol dose were significantly lower in Group KP than in Group AP. Conclusion: Ketofol provided better hemodynamic stability and quality of sedation compared with alfentanilpropofol combination in elective colonoscopy, and required fewer additional propofol; however, it prolonged discharge time. Both combinations can safely be used in colonoscopy sedation.

P apillary thyroid carcinoma (PTC) is the most common endocrine malignancy. [1] The incidence of papillary thyroid cancer is increasing tremendously in developed countries, mostly because of the determination of intrathyroidal papillary microcarcinomas that has led to suspects regarding overdiagnosis and overtreatment. [2][3][4] The incidence of thyroid carcinoma increased by three-fold between 1975 and 2009 in the US and was reported to be 15 times greater in 2011 than in 1993, which is mainly due to the initiation of a national cancer research program, in South Korea. [5,6] Although the prevalence of clinically diagnosed PTC is 1%, the prevalence of occult papillary carcinoma reaches up to a rate of 35.6% in the general population at autopsies. [7] However, despite the sudden increase in thyroid cancer, cancer mortality did not increase. [5,6] Papillary thyroid microcarcinomas (PTMCs) are tumors with Papillary thyroid carcinoma is the most common endocrine malignancy. Papillary thyroid microcarcinomas (PTMCs) are tumors with a size of ≤1 cm. The biological behavior of these tumors differs due to the presence of their aggressive features. The prognosis of PTMCs with high-risk features, such as clinical node metastasis, distant metastasis, and significant extrathyroidal extension to the tracheal or recurrent laryngeal nerve invasion, is poor, even if a sufficient immediate surgery is performed at diagnosis. However, PTMCs without these aggressive features are low-risk tumors because of their indolent and slow growth behaviors. The increase in thyroid cancer incidence is mostly a result of overdiagnosis of small low-risk PTMCs with indolent clinical course. Despite the sudden increase in thyroid cancer incidence worldwide, cancer mortality did not increase. Although the traditional treatment strategy for PTMC is immediate surgery at diagnosis, because of the rather low disease-specific mortality rate, low recurrence rate, and potential risk for postoperative complications, active surveillance has been proposed recently as an alternative option for PTMCs without invasion, metastasis, or cytological or molecular characteristics. The recent data support that active surveillance of low-risk PTMC should be the initial treatment modality, because only a small percentage of low-risk PTMCs show signs of progression, and delayed surgery has not caused significant recurrence. However, recent management guidelines are shifting toward more conservative treatments, such as active surveillance. Although there is an increase in the number of studies related to active surveillance, prospective studies have been mostly from academic referral centers in Japan. The world still needs class 1 evidence extended prospective studies originating from different geographic regions. Active surveillance may be a good alternative to immediate surgery for appropriately selected patients with PTMC.

SLMA can be a suitable alternative to intubation in laparoscopic surgical procedures in a group of selected patients.