Clinical Usefulness of the Valsalva Manoeuvre to Improve Hemostasis during Thyroidectomy

Pacilli, Mario; Pavone, Giovanna; Gerundo, Alberto; Fersini, Alberto; Ambrosi, Antonio; Tartaglia, Nicola

doi:10.3390/jcm11195791

Cited by 3 publications

(2 citation statements)

References 27 publications

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“…In addition, the Valsalva manoeuvre should be used before closing the surgical field, due to the fact that the patient's pressure during general anaesthesia is lower than under normal conditions. Raising the pressure helps visualise bleeding that could not be seen at a lower pressure [122,135]. A 2020 study from Istanbul University suggests that it is useful to apply a peak airway pressure (PAP) of 50 cm H 2 O for 22.5 s to help visualise bleeding sites.…”

Section: Operating Techniquesmentioning

confidence: 99%

Modern Surgical Techniques of Thyroidectomy and Advances in the Prevention and Treatment of Perioperative Complications

Ludwig,

Dziekiewicz

et al. 2023

Cancers

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Thyroid cancer is the most common cancer of the endocrine system, and, in recent years, there has been a phenomenon of overdiagnosis followed by subsequent overtreatment. This results in an increasing number of thyroidectomy complications being faced in clinical practice. In this paper, we present the current state of knowledge and the latest findings in the fields of modern surgical techniques, thermal ablation, the identification and assessment of parathyroid function, recurrent laryngeal nerve monitoring and treatment and perioperative bleeding. We reviewed 485 papers, from which we selected 125 papers that are the most relevant. The main merit of this article is its comprehensive view of the subject under discussion—both general, concerning the selection of the appropriate method of surgery, and particular, concerning the selection of the appropriate method of prevention or treatment of selected perioperative complications.

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Section: Operating Techniquesmentioning

confidence: 99%

Modern Surgical Techniques of Thyroidectomy and Advances in the Prevention and Treatment of Perioperative Complications

Ludwig,

Dziekiewicz

et al. 2023

Cancers

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show abstract

“…Data from 2006 to 2012 indicate that the annual incidence of thyroid cancer is approximately 5.4% in men and 6.5% in women. In addition, thyroid cancer is the fifth most common malignant tumor in women and the most common cancer in women under the age of 25, with an average annual incidence rate of 6.2% ( 2 , 3 ). Surgery is certainly still the cornerstone in treatment and implicates the removal of the thyroid with associated removal of the involved cervical lymph nodes.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided approach to surgery for nodal recurrence following lateral neck dissection for differentiated thyroid carcinoma. A single institution experience

Pacilli,

Pavone,

Quazzico

et al. 2024

Front. Surg.

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IntroductionTotal thyroidectomy (TT) and central neck dissection (CND) had a significant effect on the reduction of local recurrence compared with TT alone. Lateral Neck Dissection (LND) was performed in all the cases with therapeutic intent. The suspicion of nodal recurrence is provided by the appearance of one or more enlarged nodes in the central and/or laterocervical compartment during the follow up period.MethodsFrom January 2018 to November 2023, 16 patients at the University General Surgery unit of the Polyclinic of Foggia underwent reoperation due to nodal recurrence after previously undergoing total thyroidectomy with central and lateral cervical dissection.ResultsAll surgical interventions were approached with intraoperative ultrasound performed by the operating surgeon. In all cases, ultrasound identification of the suspicious lymph node led to histological confirmation of malignancy. In only two cases it was necessary to carry out an extemporaneous intraoperative histological examination. No complications were recorded during the operations.ConclusionsSurgical reintervention in patients with nodal recurrence is challenging and requires an assessment by members of the interdisciplinary team. The ideal method should be economically convenient, easy to practice, with a quick learning curve, easily reproducible, and safe for patients. Intraoperative, ultrasound-guided, is a safe and effective technique. It facilitates tumor localization and removal, especially in patients requiring re-operative neck surgery.

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Comparison of two techniques of administering the Valsalva manoeuvre in patients under general anaesthesia: A randomised controlled study

Shah,

Chaudhary,

Chawla

et al. 2024

Indian Journal of Anaesthesia

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Background and Aims: Surgeons often request a Valsalva manoeuvre (VM) at the end of surgery (head–neck surgery, craniotomy) to check haemostasis and to unmask covert venous bleeders. We aimed to compare an anaesthesia machine-generated objective technique for delivering VM under pressure-control (PC) mode with the traditional subjective technique of delivering VM in manual mode. Methods: This randomised controlled study included 60 adult patients randomised to manual (Group M) and controlled ventilation (Group C) groups. Our primary outcome measure was internal jugular vein (IJV) diameter at pre-determined time points (T0 = baseline, T1 = VM initiation, T2 = 20 s after VM initiation, T3 = immediately after VM release, and T4 = 1 min, T5 = 2 min and T6 = 5 min post-VM release). Secondary outcome measures included mean arterial pressure (MAP), heart rate, time to desired plateau airway pressure, number of patients with bleeders unmasked and surgeon satisfaction. Independent/paired sample t-tests were applied. Results are expressed as mean (standard deviation), mean difference (95% confidence interval), dotted box–whisker plots and trendlines. P <0.05 is considered statistically significant. Results: Mean differences in diameter changes in IJV (in centimetres) in the mediolateral and anteroposterior directions between Group C and Group M were -0.136 (-0.227, -0.044) and -0.073 (-0.143, -0.002), respectively. VM in the PC mode produced more significant IJV dilatation (P = 0.004, P = 0.044). MAP at T0 and T1 was comparable. At T2 and T3, there was a more significant fall in MAP in Group C versus Group M (P = 0.018 and P = 0.021, respectively). At T4, T5 and T6, MAP was comparable. Conclusion: Performing VM in PC mode is a better technique based on IJV diameter, haemodynamics, bleeder unmasking and surgeon satisfaction.

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Clinical Usefulness of the Valsalva Manoeuvre to Improve Hemostasis during Thyroidectomy

Cited by 3 publications

References 27 publications

Modern Surgical Techniques of Thyroidectomy and Advances in the Prevention and Treatment of Perioperative Complications

Modern Surgical Techniques of Thyroidectomy and Advances in the Prevention and Treatment of Perioperative Complications

Ultrasound-guided approach to surgery for nodal recurrence following lateral neck dissection for differentiated thyroid carcinoma. A single institution experience

Comparison of two techniques of administering the Valsalva manoeuvre in patients under general anaesthesia: A randomised controlled study

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