際際滷

際際滷Share a Scribd company logo

Anaesthetic management of goitre

Download as PPTX, PDF
S
Sapan Jena

A 65 year old female from sundergarh presented with swelling in front of neck gradually increasing size over 3 years without airway compromise,complications,any other comorbid conditions , diagnosed as hypothyroidism 2 yrs back & is on treatment with levothyroxine with FNAC diagnosis diffuse colliod goiter pattern & ECG showing RBBB pattern.

1 of 23
Download to read offline
A 65 YEAR OLD FEMALE DIAGNOSED WITH COLLOID GOITRE POSTED FOR HEMITHYRIODECTOMY UNDER ANAESTHESIA By Dr sapan kumar jena MD Anaesthesiology
PATIENT DETAILS Name : Tilotama seth w/o : Late Gourisanker seth Age /sex : 65 yr female Address: sankara , sundergarh Weight: 58 kg Height : 150cm Date of admission: 11 july 2018 Regd no: 2729
Chief complints: Swelling in front of neck 3 years History of present illness: Patient was apparently alright 3 years back ,to start with she noticed a swelling in front of neck which is gradually increasing size . It was not associated with pain , difficulty in breathing ,difficulty in swallowing or any voice change. There was no history of tremor ,palpitation, diarrhoea , constipation. Bowel & bladder habits normal.
History of past illness: She is a known case of hypothyriodism ,taking Levothyroxine 100 mg once daily since 1 year No h/o TB,DM,Hypertension,asthma ,seizure disorder,sickle cell disease No past surgical history Family history : nothing suggestive Treatment history: Taking levothyroxine 100 mg once daily since 1 yr Personal history : Belongs to low socioeconomic status Married & blessed with two children Menstual history: Menopause 15 yr back
GENERAL EXAMINATION Patient conscious ,oriented , afebrile Height : 150 cm Weight : 58 kg Pallor ++, No icterus, cyanosis,clubbing, lymphadenopathy,edema No proptosis or lid lag PR =65/min regular ,good volume and character, all peripheral pulses well felt with no radioradial or radiofemoral delay. BP: 110/70 mm Hg rt arm supine position RR: 14/min regular abdomino thoracic Temp : 98.2 尊F
AIRWAY EXAMINATION Mallampatti grade : II Mouth opening : allowing 3 fingers Thyromental distance = 6.8 cm Sternomental distance = 13cm Dentition : normal ,no loose tooth,bucked tooth or artificial dentures Cervical spine : no resticted mobility
LOCAL EXAMINATION Inspection: Size : 4cm x 3 cm Shape: globular Location : at middile of neck Palpation : Diffuse ,smooth surface, regular margin , firm, nontender,mobile ,no local rise of temprature, no pulsation Moves with deglution, not with protrusion of tongue Getting below the swelling is possible No cervical lymphadenopathy Auscultaion : no bruit is heard
SYSTEMIC EXAMINATION Respiratory system: chest B/L symmetrical,trachea central B/L vesicuar breath sounds , no added sound CVS : S1 S2 heard, no murmer Per abdomen : soft nontender , no hepatomegaly , spleen is not palpable CNS: cranial nernes intact , higher motor functions normal . Deep tendon reflexes normal
PROVISIONAL DIAGNOSIS Diffuse colloid goiter
INVETIGATIONS Hematology: Hb: 10.4 gm/dl DC = N 78 L 20 E2 TLC= 7800/cumm Biochemical profile Serum Na+ = 140 mmol/L S. K+ = 3.6 mmol/L S. urea= 26 mg/dl S. creatinine= 1.1mg/dl RBS= 128 Coagulation profile BT= 2 min 60 sec CT= 4 min 15 sec
Serology : HIV,HBV,HCV are nonreactive Thyriod profile: Total T3= 0.94 ng/ml Total T4= 10.09 袖g/dl TSH = 1.22 袖IU/ml ECG: RBBB
Anaesthetic management of goitre
FNAC : colliod goiter with cyctic degeneration
FINAL DIAGNOSIS Diffuse colliod goiter
SUMMERY A 65 year old female from sundergarh presented with swelling in front of neck gradually increasing size over 3 years without airway compromise,complications,any other comorbid conditions , diagnosed as hypothyroidism 2 yrs back & is on treatment with levothyroxine with FNAC diagnosis diffuse colliod goiter pattern & ECG showing RBBB pattern. She was posted for hemithyriodectomy under anaesthesia
PLAN OF SURGERY Hemithyriodectomy
PLAN OF ANAESTHESIA General anaesthesia with endotracheal intubation and positive pressure ventilation
PREANAETHETIC CHECK UP Nil per oral 8 hours before surgery Adequate blood for intraoperative requirement Tab ranitidine 150 mg night before surgery Tab alprax 0.25 mg night before surgery Levothyroxine to be continued on morning of surgery ENT consultation for indirect laryngoscopy Lateral view X ray of neck
MONITERING Pulse oxymetry NIBP ECG EtCO2 Temperature monitioring
ANAESTHETIC MANAGEMENT Premedication: Inj glycopyrrolate 0.2mg iv Inj midazolam 1.5mg iv Inj nalbuphine 10 mg iv Inj ranitidine 50 mg iv Inj ondansetron 4mg iv Induction : Inj Propofol 100 mg iv Inj succinyl choline 100 mg iv Intubation : Under direct laryngoscopy ,intubation performed with 6.5 mm ID cuffed flexomettalic tube fixed at right angle of mouth
ANAESTHETIC MANAGEMENT Maintainance : Inj vecuronium 5mg iv loading dose N2O :O2 =2:1 Sevoflurane inhation Intraoperative period: IV fluid: ringer lactate 1000 ml in first hour, 750 ml each in 2nd & 3rd hour One unit of blood was infused Inj diclofenac 75 mg iv infusion Inj hydrocortisone 200 mg iv inj vecuronium 1mg at 30 min interval
ANAESTHETIC MANAGEMENT Reversal : Inj neostigmine 2.5 mg iv Inj glycopyrrolate 0.5 mg iv Extubation : done after thorough suctioning & regular breathing pattern Post operative Nil per oral for 6 hours Vitals monitoring O2 inhalation IVF ringer lactate 500ml over 6 hours Inj diclofenac im 8hourly Inj ranitidine 50 mg iv 8hourly Antibiotic prophylaxis
Anaesthetic management of goitre

More Related Content

Anaesthetic management of goitre

  • 1. A 65 YEAR OLD FEMALE DIAGNOSED WITH COLLOID GOITRE POSTED FOR HEMITHYRIODECTOMY UNDER ANAESTHESIA By Dr sapan kumar jena MD Anaesthesiology
  • 2. PATIENT DETAILS Name : Tilotama seth w/o : Late Gourisanker seth Age /sex : 65 yr female Address: sankara , sundergarh Weight: 58 kg Height : 150cm Date of admission: 11 july 2018 Regd no: 2729
  • 3. Chief complints: Swelling in front of neck 3 years History of present illness: Patient was apparently alright 3 years back ,to start with she noticed a swelling in front of neck which is gradually increasing size . It was not associated with pain , difficulty in breathing ,difficulty in swallowing or any voice change. There was no history of tremor ,palpitation, diarrhoea , constipation. Bowel & bladder habits normal.
  • 4. History of past illness: She is a known case of hypothyriodism ,taking Levothyroxine 100 mg once daily since 1 year No h/o TB,DM,Hypertension,asthma ,seizure disorder,sickle cell disease No past surgical history Family history : nothing suggestive Treatment history: Taking levothyroxine 100 mg once daily since 1 yr Personal history : Belongs to low socioeconomic status Married & blessed with two children Menstual history: Menopause 15 yr back
  • 5. GENERAL EXAMINATION Patient conscious ,oriented , afebrile Height : 150 cm Weight : 58 kg Pallor ++, No icterus, cyanosis,clubbing, lymphadenopathy,edema No proptosis or lid lag PR =65/min regular ,good volume and character, all peripheral pulses well felt with no radioradial or radiofemoral delay. BP: 110/70 mm Hg rt arm supine position RR: 14/min regular abdomino thoracic Temp : 98.2 尊F
  • 6. AIRWAY EXAMINATION Mallampatti grade : II Mouth opening : allowing 3 fingers Thyromental distance = 6.8 cm Sternomental distance = 13cm Dentition : normal ,no loose tooth,bucked tooth or artificial dentures Cervical spine : no resticted mobility
  • 7. LOCAL EXAMINATION Inspection: Size : 4cm x 3 cm Shape: globular Location : at middile of neck Palpation : Diffuse ,smooth surface, regular margin , firm, nontender,mobile ,no local rise of temprature, no pulsation Moves with deglution, not with protrusion of tongue Getting below the swelling is possible No cervical lymphadenopathy Auscultaion : no bruit is heard
  • 8. SYSTEMIC EXAMINATION Respiratory system: chest B/L symmetrical,trachea central B/L vesicuar breath sounds , no added sound CVS : S1 S2 heard, no murmer Per abdomen : soft nontender , no hepatomegaly , spleen is not palpable CNS: cranial nernes intact , higher motor functions normal . Deep tendon reflexes normal
  • 10. INVETIGATIONS Hematology: Hb: 10.4 gm/dl DC = N 78 L 20 E2 TLC= 7800/cumm Biochemical profile Serum Na+ = 140 mmol/L S. K+ = 3.6 mmol/L S. urea= 26 mg/dl S. creatinine= 1.1mg/dl RBS= 128 Coagulation profile BT= 2 min 60 sec CT= 4 min 15 sec
  • 11. Serology : HIV,HBV,HCV are nonreactive Thyriod profile: Total T3= 0.94 ng/ml Total T4= 10.09 袖g/dl TSH = 1.22 袖IU/ml ECG: RBBB
  • 13. FNAC : colliod goiter with cyctic degeneration
  • 14. FINAL DIAGNOSIS Diffuse colliod goiter
  • 15. SUMMERY A 65 year old female from sundergarh presented with swelling in front of neck gradually increasing size over 3 years without airway compromise,complications,any other comorbid conditions , diagnosed as hypothyroidism 2 yrs back & is on treatment with levothyroxine with FNAC diagnosis diffuse colliod goiter pattern & ECG showing RBBB pattern. She was posted for hemithyriodectomy under anaesthesia
  • 16. PLAN OF SURGERY Hemithyriodectomy
  • 17. PLAN OF ANAESTHESIA General anaesthesia with endotracheal intubation and positive pressure ventilation
  • 18. PREANAETHETIC CHECK UP Nil per oral 8 hours before surgery Adequate blood for intraoperative requirement Tab ranitidine 150 mg night before surgery Tab alprax 0.25 mg night before surgery Levothyroxine to be continued on morning of surgery ENT consultation for indirect laryngoscopy Lateral view X ray of neck
  • 19. MONITERING Pulse oxymetry NIBP ECG EtCO2 Temperature monitioring
  • 20. ANAESTHETIC MANAGEMENT Premedication: Inj glycopyrrolate 0.2mg iv Inj midazolam 1.5mg iv Inj nalbuphine 10 mg iv Inj ranitidine 50 mg iv Inj ondansetron 4mg iv Induction : Inj Propofol 100 mg iv Inj succinyl choline 100 mg iv Intubation : Under direct laryngoscopy ,intubation performed with 6.5 mm ID cuffed flexomettalic tube fixed at right angle of mouth
  • 21. ANAESTHETIC MANAGEMENT Maintainance : Inj vecuronium 5mg iv loading dose N2O :O2 =2:1 Sevoflurane inhation Intraoperative period: IV fluid: ringer lactate 1000 ml in first hour, 750 ml each in 2nd & 3rd hour One unit of blood was infused Inj diclofenac 75 mg iv infusion Inj hydrocortisone 200 mg iv inj vecuronium 1mg at 30 min interval
  • 22. ANAESTHETIC MANAGEMENT Reversal : Inj neostigmine 2.5 mg iv Inj glycopyrrolate 0.5 mg iv Extubation : done after thorough suctioning & regular breathing pattern Post operative Nil per oral for 6 hours Vitals monitoring O2 inhalation IVF ringer lactate 500ml over 6 hours Inj diclofenac im 8hourly Inj ranitidine 50 mg iv 8hourly Antibiotic prophylaxis