Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Use of laryngeal mask airway in total thyroidectomy in a patient with ocular myasthenia and graves’ disease(Jaypee Brothers Medical Publishers (P) Ltd, 2019) Shilpage, S.; Fernando, R.; Munasinghe, N.; Gunetilleke, B.ABSTRACT: BACKGROUND: The association between Graves’ disease (GD) and ocular myasthenia (OM) is well known. Total thyroidectomy gives a permanent “cure” for GD and the literature reports a varying progression of myasthenia gravis (MG) in such patients after surgery. The main issue in patients with MG is the difficulties with the use of muscle relaxants during anesthesia. In the ensuing case report, a patient with OM and GD who had a total thyroidectomy under general anesthesia (GA) with laryngeal mask airway (LMA) without muscle relaxants is described. CASE REPORT: A 40-year-old man was clinically and biochemically diagnosed to have GD. Subsequently, he developed bilateral ptosis which was diagnosed as OM by a neurologist. Though his OM responded to treatment, his GD was not well controlled. He was admitted, monitored, and made euthyroid by adjusting the carbimazole dose. A decision was made to undertake total thyroidectomy for GD, with total intravenous anesthesia and Proseal® LMA without muscle relaxants following a discussion with the anesthetic team. A conventional total thyroidectomy was performed using nerve encountering, parathyroid preserving, and capsular dissection technique. The patient made an uncomplicated recovery. CONCLUSION: A technique combining total intravenous anesthesia and a LMA without muscle relaxants for thyroid surgery in a patient with MG has advantages over a standard method. The use of LMA in other thyroid surgeries must be further evaluated for future use. CLINICAL SIGNIFICANCE: Coexistence of MG and GD should be in mind when treating the patients with GD. Individualize the use of muscle relaxants in GA and best to avoid whenever possible. © The Author(s). 2019.Item Pre and post operative assessment of voice changes in patients undergoing total thyroidectomy(The Sri Lanka Medical Association, 2017) Dissanayake, D.M.C.D.; Fernando, R.; Munasinghe, B.N.L.; Thilakarathne, S.B.; Pinto, D.P.; Uragoda, U.A.Item Total thyroidectomy in benign disease of the thyroid(Sri Lanka Medical Association, 2005) Siriwardana, P.N.; Fernando, R.INTRODUCTION: Total thyroidectomy (TT) is a new concept in management of benign diseases of the thyroid (BDT). Many surgeons are reluctant to perform TT for BDT due to the presumed risk of recurrent laryngeal nerve (RLN) damage and hypo parathyroid ism. Subtotal thyroidectomy is associated with a higher rate of recurrence and surgery for recurrent goiter has a significantly high rate of RLN damage and hypoparathyroidisrn. The current world trend favours TT for BDT. However, there is very little data on TT for BDT in Sri Lanka. PATIENTS AND METHODS: Epidemiological data, data on thyroid illness and postoperative complications of 22 consecutive patients who underwent TT for BDT between May 2001 and Aug 2004 were recorded in a standardized proforma. RESULTS: The median age was 46.5 (range 27 - 64) years. There were 20 females and 2 males. Nine patients had toxic nodular goiters, 9 had euthyroid nodular goiters while 4 had diffuse toxic goiters. Postoperative vocal cord examination which was performed during extubation, revealed normal vocal cord function in all patients. However 8 (36.5%) patients complained of transient hoarseness of voice and 3 (13.5%) patients developed transient hypoparathyroidisrn. All these symptoms resolved within 2 months of surgery. There were no recurrences duringa mean follow-up of 15.2 months. One patient's histology revealed an incidental folltcular carcinoma. CONCLUSIONS: TT thyroidectomy is safe with a low incidence of complications. It has several advantages including dealing with occult malignancies and preventing recurrence.