Cardiac arrythmias during thyroid surgery

Abstract

Two hundred and twenty patients presenting for thyroidectomy in the New End Hospital's Surgical Endocrine unit were studied in order to find the incidence of cardiac arrythmias occurring with three common anaesthetic techniques. Each patient received the subcutaneous injection of a saline-adrenaline mixture before the start of surgery, The use of propanolol for correcting arrhythmias was evaluated.Patients of both sexes between the ages of 15 and 65 in whom no cardiovascular, respiratory or other preeexisting disease was detectable were admitted to the trial. Those patients who had toxic goitres were treated with carbimazole until they were euthyroid and this was followed by a course of Lugol's iodine immediately pre-operatively. The patients were then designated as either 'non-toxic' or 'controlled-toxic'. Pre-medication and inductionEach patient received pethidine, promethazine and atropine one hour pre-operatively in a dosage estimated to achieve a uniform degree of sedation. Before anaesthesia an ECG recording of all six standard leads was taken on a Cardiofax writer. Thereafter lead I1 was continually monitored on a Stanley Cox oscilloscope linked to the Cardiofax. Anaesthesia was induced using thiopentone, 5mg/kg, followed by suxamethonium, 50-75 mg. After inflation with oxygen the patient was intubated with a red rubber cuffed Magill tube smeared with 4 % lignocaine cream and the cuff was inflated to achieve occlusion of the trachea. In no case was the trachea sprayed with local analgesic. Series 1 100 patients Spontaneous respiration: halothane-nitrous oxide-oxygen.Following the induction as described above nitrous oxide, 6 litres/minute and oxygen 3 litres/minute, were directed through a Fluotec vaporizer

Comparison of three different formulations of local anaesthetics for cervical epidural anaesthesia during thyroid surgery

“…[19] We observed a haemorrhagic tap in two patients during epidural space localization thus mandating conversion to GA. Previous studies have documented a proportionately higher risk of hypotension and arrhythmias during thyroid surgeries under GA.[120] In contrast, Khanna et al . mentioned no cardiovascular complications during thyroid surgeries under CEA.…”

Reflections on Beta-Adrenergic Blockade in Anaesthetics

“…It causes a slight prolongation of the atrioventricular conduction time, but unlike quinidine and procainamide, has no effect on intraventricular conduction (Berkowitz et al, 1969). It has been used successfully in the treatment of cardiac arrhythmias in anaesthetized patients (Hellewell and Potts, 1965;Johnstone, 1966;Bird et al, 1969). The effective dose in adults ranges between 0.5 and 10.0 mg according to the intensity of the adrenergic stimulus to be controlled.…”

“…It has also been used to control the cardiac dysrhythmias of induced hypothermia (Cole and Jacobs, 1967;Finlay and Dykes, 1968), and some of the dysrhythmias provoked by cardiac surgery (McOish et al, 1968;Muller and Dietzel, 1967). Cardiac disturbances of thyrotoxic origin appearing during anaesthesia have also responded favourably to beta blockade (Bird et al, 1969). The malignant hyperpyrexia provoked by anaesthesia in experimental animals is unaffected by propranolol (Harrison et al, 1969).…”

The Interactions between β‐Blockers and Anaesthetics. Experimental Observations

“…Thus, it is now generally accepted that adrenergic beta-receptor blockade should be maintained throughout the peri-operative period in order to protect the cardiovascular system of patients with ischaemic or hypertensive heart disease (PRY% ROBERTS et al 1973, BOUDOKJLAS et al 1979, M.\NSERS & WALTERS 1979, OKA et al 1980. Adrenergic beta-receptor antagonists may also be used deliberately in order to prevent dysrhythmias associated with laryngoscopy, endotracheal intubation and bronchoscopy (PRYS-ROBERT^ et al 1973, JENKINS 1970, developing during dental surgery (RYDER et al 1971, ROI.I.ASON & RIJSSEIL 1980, cardiac and vascular surgery (MORAN et al 1973, OKA et al 1980, neurosurgery (WHITBY 1963), surgery of the thyroid gland, (BIRD et al 1969, TRENCH et al 1978 and of phaeochromocytoma (BIYGHAM et al 1972). They are also effective in the prevention and treatment ofhypertensive crises caused by anaesthetic or surgical manoeuvres (HEI.I.…”