piperidines and Thyroid-Nodule

This study was designed to investigate whether stepwise tapering of remifentanil at the end of surgery could decrease postoperative pain scores and requirements of rescue analgesics after remifentanil-desflurane anesthesia in patients with thyroidectomy.. Sixty two patients undergoing thyroidectomy under general anesthesia were randomly allocated into two groups. All patients were anesthetised with desflurane and high-dose remifentanil. Remifentnail was infused at the rate of 0.3 μg/kg/min until the end of surgery in patients of the control group (group A) whereas remifentanil was tapered gradually from 0.3 to 0.1 μg/kg/min until the end of surgery for at least 30 minutes in patients with group B. Pain scores (0-100 numerical rating scale, NRS), rescue analgesic requirements and adverse events were assessed at 30 min, 2 h, 6 h, 12 h, and 24 h after operation.. There was a significant decrease in pain scores at 30 min (20 [0-80] vs. 50 [0-100], P = 0.002) and 2 h (30 [10-60] vs. 40 [20-80], P = 0.018) after surgery in group B compared with group A. In addition, rescue analgesics are less required in group B than in group A postoperatively (2 [1-3] vs. 3 [2,3], P = 0.039). There were no significant differences in adverse events between the two groups.. Tapering of remifentanil at the end of surgery decreased postoperative pain scores immediately after thyroidectomy with desflurane and high-dose remifentanil anesthesia.. Clinical Research information Service (CRiS, registration number KCT0000589).

Topics: Adult; Aged; Analgesics; Anesthesia Recovery Period; Anesthetics, Combined; Anesthetics, Inhalation; Anesthetics, Intravenous; Desflurane; Female; Humans; Infusions, Intravenous; Isoflurane; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Piperidines; Prospective Studies; Remifentanil; Single-Blind Method; Thyroid Neoplasms; Thyroid Nodule; Thyroidectomy; Young Adult

Acute invasive fungal infections of the head and neck secondary to tyrosine kinase inhibitors are rare and potentially life-threatening events.. We report a case of mucormycosis of the thyroid gland in a patient known for chronic lymphocytic leukemia receiving ibrutinib who presented with a rapidly growing thyroid nodule and dysphonia. An acute invasive fungal infection was identified on a core needle biopsy; mucormycosis was confirmed on culture. The patient was successfully treated with surgical debridement and long-term antifungal therapy.. Patients on ibrutinib may be at risk of acute invasive fungal infections of the head and neck.

Topics: Adenine; Agammaglobulinaemia Tyrosine Kinase; Aged; Cunninghamella; Humans; Immunocompromised Host; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Mucormycosis; Piperidines; Pyrazoles; Pyrimidines; Thyroid Nodule

Topics: Biopsy, Fine-Needle; Calcitonin; Carcinoma, Neuroendocrine; Diagnosis, Differential; Female; Humans; Lymph Nodes; Lymphatic Diseases; Middle Aged; Neck; Piperidines; Quinazolines; Receptors, Vascular Endothelial Growth Factor; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule; Thyrotropin; Tomography, X-Ray Computed; Ultrasonography