Tarasenko S. Personalised approach to perioperative anaesthetic management of thyroidectomy in patients with thyrotoxicosis

The study provides considerable evidence for the modern thyroid surgery. The findings reinforce the of surgical treatment improvement of thyrotoxicosis patients by choosing the method of anaesthesia and by optimizing the perioperative anaesthesia. The new reliable data obtained allowed to solve the actual problem of anaesthesia management of thyrotoxicosis patients. The evidence from this study points towards the idea of a personified approach to the general anaesthesia and perioperative anaesthesia choice using a complex of balanced analgesia and modern anaesthesia control methods. The results of this study indicate that thyrotoxicosis deteriorates the physical status of the patient according to ASA. Our investigations into this area seem likely to confirm the hypothesis that combined anaesthesia with BSCPB performed as a pre-emptive analgesia with IMFA with sevoflurane or TIVA propofol provides statistically (p <0.05) significant improvement in pain relief compared to monoanaesthesia. Better nociceptive monitoring with combined anaesthesia contributes significantly lower intraoperative blood loss - 44.03 ± 3.71 ml compared to 69.57 ± 4.47 ml in monoanaesthesia. The best antiemetic scheme was proved to be the use of BA combined with basic anaesthesia with propofol in the BA-P subgroup with the addition of metoclopramide before anaesthesia induction. The highest rate of patients did not experience PONV - 77.3%. The study also demonstrates that the intraoperative analgesics consumption is significantly lower with IMFA / ILFA with sevoflurane compared to TIVA with propofol: statistically significant (p <0.05) decrease in the fentanyl consumption in subgroups of IA-BA-S and CS compared to the subgroups of TIVA - in the BA-P subgroup and CP respectively. The most economically feasible is the use of IA sevoflurane for a minimum flow path - in the BA-S subgroup, the cost of anaesthesia was 170.24 ± 4.22 UAH, 183.28 ± 4, 12 UAH. The concept and anaesthetic management algorithm in thyrotoxicosis patients undergoing thyroidectomy have been created, and the usage IMFA or ТІVА has been justified.