Gland and Hormone Related Diseases

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Thyroid Diseases

Thyroid Neoplasms

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Dexmedetomidine

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Anesthetics, General

After induction of anesthesia, anesthesia is maintained with desflurane and remifentanil during thyroidectomy.

Fifteen minutes before the end of surgery, infusion of remifentanil for surgery is discontinued.

Then, dexmedetomidine has started infusion for 15 min (rate of 0.6 ug/kg/hr). Vital signs and complications of testing drugs are measured before and after infusion of testing drugs.

Five minutes before the end of surgery, anesthetic gas (desflurane) is discontinued.

After patient has awake, extubation has done. Extubation time and Recovery time,Cough reflex,Ramsay Sedation Scale, Visual analogue scale, and surgical outcomes such as postoperative bleeding, time to remove drainage and duration of hospital staying, postoperative complications are measured until POD#3.

After induction of anesthesia, anesthesia is maintained with desflurane and remifentanil during thyroidectomy.

Fifteen minutes before the end of surgery, infusion of remifentanil for surgery is discontinued. Then, normal saline has started infusion for 15 min (same rate as Group D). Vital signs and complications of testing drugs are measured before and after infusion of testing drugs.

Five minutes before the end of surgery, anesthetic gas (desflurane) is discontinued.

After patient has awake, extubation has done. Extubation time and Recovery time,Cough reflex,Ramsay Sedation Scale, Visual analogue scale, and surgical outcomes such as postoperative bleeding, time to remove drainage duration of hospital staying, postoperative complications are measured until POD#3.

Remifentanil is infused for the maintenance of anesthesia during surgery and discontinued 15 min before end of surgery

The aim of this study is evaluation of effect of dexmedetomidine on emergence response and postoperative outcome after thyroidectomy

Thyroidectomy

Systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate are measured before infusion of testing drugs, after infusion of them (5 min, 10 min, and 15 min), during extubation (0 min and 5 min after extubation), and at recovery room.

And the complications such as hypotension, hypertension, bradycardia, tachycardia, and desaturation after infusion of testing drugs are observed.

Vital signs

During recovery from anesthesia at operation room, cough reflex is measured and rated. \[Grade 0, no cough; Grade 1, single cough with mild severity; Grade 2, cough persistence less than 5 s with moderate severity; Grade 3, severe, persistent cough for more than 5 s (bucking)\]

Cough reflex

When the patient has fully awaken and transferred to the recovery room, Ramsay Sedation Scale is measured.

1. Awake Patient anxious and agitated or restless or both!
2. Patient cooperative, oriented and tranquil!
3. Patient responds to commands only!
4. Asleep A brisk response to a light glabellar tap or loud auditory stimulus!
5. A sluggish response to a light glabellar tap or loud auditory stimulus!
6. No response to a light glabellar tap or loud auditory stimulus

Ramsay Sedation Scale

The time from discontinuing anesthetic gas to endotracheal extubation is measured.

And the time from the discontinuing of anesthetic gas to transferring to the recovery room is also measured.

Extubation time and Recovery time

The severity of pain after surgery is measured by VAS (at recovery room, POD 1, POD 2, and POD 3)

Visual analogue scale

The amount of postoperative bleeding which is collected in the barovac is measured.

Postoperative bleeding

Postoperative complications after thyroidectomy such as hoarseness and hematoma, and reoperation due to such complication is observed.

Postoperative complications

The time from the end of surgery to remove drainage is measured. And the duration of hospital staying is measured.

Time to remove drainage and duration of hospital staying

Dexmedetomidine has started infusion for 15 min (rate of 0.6 ug/kg/hr) before end of surgery as experimental intervention

Normal saline has started infusion for 15 min (as same rate of dexmedetomidine) before end of surgery as control intervention

Normal saline

Ki Tae Jung, M.D.

The purpose of the present study was to compare the effect of dexmedetomidine which is administered during emergence in adult patients undergoing elective thyroidectomy on smooth emergence form general anesthesia (reducing agitation or coughing, signs of hypertension or tachycardia, or etc.) and postoperative outcome (postoperative bleeding and hospital staying).

Smooth emergence from general anaesthesia after surgery is important to prevent potentially dangerous effects such as hypertension, tachycardia, myocardial ischaemia, arrhythmias and increased intracranial and intra-abdominal pressure. After thyroidectomy, activities during emergence such as agitation or coughing, signs of hypertension or tachycardia, or etc. may lead to postoperative bleeding, resulting in acute airway obstruction or reoperation.

The purpose of the present study was to compare the effect of dexmedetomidine which is administered during emergence in adult patients undergoing elective thyroidectomy on smooth emergence form general anesthesia and postoperative outcome.

Effect of Dexmedetomidine After Thyroidectomy

Effect of Dexmedetomidine Infusion for Postoperative Outcome and Smooth Emergence After Thyroidectomy

Systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate

Hypertension, hypotension, bradycardia, tachycardia, and desaturation after infusion of dexmedetomidine or normal saline

Postoperative bleeding: Sum of bleeding via barovac

time to extubation from the end of surgery

time to transfer to recovery room from the end of surgery

Coughing Response during recovery from anesthesia

Chosun University Hospital

Assist Professor

Drink 30-50ML of normal temperature water after meeting the PACU transfer out standard. If the patient swallows successfully and does not cough, after returning to the ward, the medical staff of the ward will guide him or her to resume drinking and eating early: patient will resume drinking water within one hour after returning to the ward, a small amount of water for many times until the amount of drinking water reaches 300ml. If the patient does not have discomfort symptoms, he or she will resume eating according to normal drinking and eating habits.

Drink 30-50ML of normal temperature water after 6h after the operation. A small amount of water can be used several times, and the amount of water can reach 300ml. If the patient does not have any discomfort symptoms, it can guide the patient to recover diet according to his/her normal eating habits.

Early resumption of oral intake

Late resumption of oral intake

Shen Le, PhD

Wu Juelun, Master

This study is a single-center, prospective and randomized controlled study to investigate the effects of early recovery of oral intake (E) and late recovery of oral intake (L) on postoperative recovery quality and satisfaction of patients undergoing thyroid surgery. The study's primary outcome is quality of recovery-15 scale (Qor-15).

The subjects of this study are patients who will receive thyroid surgery in Peking Union Medical College Hospital. After the patient is included in the experiment, when the patient meets the exit criteria of the PACU, the patient will be randomly assigned to early resumption of oral intake group and late resumption of oral intake group to receive different treatments. Finally, researchers will collecte and evaluate the different outcome indicators of the two groups of patients.

Randomized controlled trial：Participants who enroll in RCTs differ from one another in known and unknown ways that can influence study outcomes, and yet cannot be directly controlled. By randomly allocating participants among compared treatments, an RCT enables statistical control over these influences. Provided it is designed well, conducted properly, and enrolls enough participants, an RCT may achieve sufficient control over these confounding factors to deliver a useful comparison of the treatments studied.

The anesthesiologists will obtain the group of patients through computer randomization before the patients leave the Post-Anesthesia Care Unit, and guide the patients to drink water. The questionnaire collectors and outcomes assessor will not be informed of the group of patients.

Effect of Early Postoperative Drinking Water on Postoperative Recovery Quality of Patients With Thyroid Surgery

Using QoR-15 questionnaire to evaluate the quality of perioperative recovery. QoR-15 consists of 15 comprehensive questions, including physical comfort (5 items), psychological support (2 items), physical independence (2 items), emotional state (4 items), and pain (2 items), each item is scored with 0-10 points, 0 represents poor state, 10 represents good state, and the total score is the QoR-15 score of the patient.

The overall satisfaction of the patients during hospitalization was scored immediately before the patients were discharged from the hospital. The patients were scored according to 0-10 points, 0 being completely dissatisfied and 10 being completely satisfied.

The patients were given self-evaluation before the first drinking water and 8 hours after the operation. They were divided into pharyngeal pain and surgical incision pain, which were scored according to 0-10 points respectively. 0 point was completely painless, and 10 point was unbearable pain.

Postoperative defecation and exhaustion time

Peking Union Medical College Hospital

3 trocars are needed. two in the circumareolar region and one in the parasternal region. the dissection area begins from the trocar site and extends to the neck.

the dissection is reduced by creating a long tunnel from the trocar site and the dissection area confined in the upper chest wall and in the neck.

endoscopic thyroidectomy via the breast approach. the difference between two arms is in the subcutaneous dissection area.

endoscopic thyroidectomy

wei zhang, MD

ming qiu, MD

cheng-xiang shan, MD

sheng liu, MD

The purpose of this study is to investigate whether reduced subcutaneous dissection area could offer patients more clinical benefits.

To create a working place in the chest wall is an inevitable step of endoscopic thyroidectomy. Large subcutaneous area was considered a drawback of endoscopic thyroidectomy. The purpose of this study is to investigate whether subcutaneous dissection area has influence on clinical outcome of endoscopic thyroidectomy, such as post-operative pain, complication rate and post-operative discomfort.

Impact of Dissection Area on the Clinical Outcome of Endoscopic Thyroidectomy

Clinical Benefits of Reduced Subcutaneous Dissection in Endoscopic Thyroidectomy

24hs after operation, post-operative pain is evaluated by VAS(visual analoge scale)

record how many patients had adverse effects(eg. bruise, seroma, hematoma, hoarseness,hypocalciemia)

Second Military Medical University

department of general surgery

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Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Effect of Dexmedetomidine After Thyroidectomy	NCT02412150	Thyroid Tumor	Desflurane Remifentanil Thyroidectomy Vital signs Cough reflex Ramsay Sedation... Extubation time... Visual analogue... Postoperative b... Postoperative c... Time to remove ... Dexmedetomidine Normal saline	20 Years - 60 Years	Chosun University Hospital
Effect of Early Postoperative Drinking Water on Postoperative Recovery Quality of Patients With Thyroid Surgery	NCT05532384	Thyroid Tumor	Early resumptio... Late resumption...	18 Years -	Peking Union Medical College Hospital
Impact of Dissection Area on the Clinical Outcome of Endoscopic Thyroidectomy	NCT01338597	Thyroid Tumor	endoscopic thyr...	18 Years - 50 Years	Second Military Medical University
Effect of Dexmedetomidine After Thyroidectomy	NCT02412150	Thyroid Tumor	Desflurane Remifentanil Thyroidectomy Vital signs Cough reflex Ramsay Sedation... Extubation time... Visual analogue... Postoperative b... Postoperative c... Time to remove ... Dexmedetomidine Normal saline	20 Years - 60 Years	Chosun University Hospital
Integrated Cancer Repository for Cancer Research	NCT02012699	Pancreatic Canc... Thyroid Cancer Lung Cancer Esophageal Canc... Thymus Cancer Colon Cancer Rectal Cancer Gastrointestina... Anal Cancer Bile Duct Cance... Duodenal Cancer Gallbladder Can... Gastric Cancer Liver Cancer Small Intestine... Peritoneal Surf... Familial Adenom... Lynch Syndrome Bladder Cancer Kidney Cancer Penile Cancer Prostate Cancer Testicular Canc... Ureter Cancer Urethral Cancer Hypopharyngeal ... Laryngeal Cance... Lip Cancer Oral Cavity Can... Nasopharyngeal ... Oropharyngeal C... Paranasal Sinus... Nasal Cavity Ca... Salivary Gland ... Skin Cancer Central Nervous... Central Nervous... Mesothelioma Breast Cancer Leukemia Melanoma Sarcoma Unknown Primary... Multiple Myelom... Ovarian Cancer Endometrial Can... Vaginal Cancer Neuroendocrine ... Plasma Cell Dys... Healthy Control		19 Years - 110 Years	University of Nebraska

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