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PROGNOSIS OF CARDIAC COMPLICATIONS IN ENDOCRINE SURGERY
S.Sh. Joniev
1,2
, A. Fazilov
1
, M. Azimov
1
1
Samarkand State Medical University,
2
Samarkand regional branch of the Republican
specialized scientific practical medical center of Cardiology, Samarkand, Uzbekistan
Abstract:Thyroid disorders rank among the most prevalent conditions in
endocrinology. Cardiovascular complications associated with these disorders not only
impair patients' quality of life but also substantially elevate the risk of adverse surgical
outcomes, with surgery being the primary definitive treatment. Consequently, many
researchers in scientific literature regard both existing and emerging thyrotoxicosis as
contraindications for elective thyroid surgery. Recent advancements have significantly
broadened the scope of anesthesiological techniques employed during thyroid gland
procedures. This article evaluates the preoperative preparation of patients with toxic
and non-toxic goiter, as well as their management during the perioperative period.
Keywords: thyroid gland, toxic goiter, non-toxic goiter, thyrotoxicosis,
premedication, analgesics, ketamine, narcotic analgesics, sevoflurane, xenon.
According to the World Health Organization, more than 300 million people
worldwide are infected with endemic goiter, which is 7% of the world's population.
Diffuse non-toxic and nodular goiter occupies an important place in the structure of
morbidity of the population and is second only to diabetes in terms of frequency of
occurrence among endocrine diseases [4]. The prevalence of nodular and mixed goiters
in the population is 21%, and all of them require surgical treatment [3,4]. There have
been no cases of decrease in the high rates of the disease. In the last 10 years, thyroid
gland surgery has significantly developed abroad and in our country. The effectiveness
of the treatment of diffuse nontoxic and nodular goiter, including thyroid pathology,
with drugs and surgery, has been substantiated by many studies, in which the
metabolism and mechanism of action of thyroid hormone biosynthesis, as well as toxic
goiter, has been studied [5]. Although significant progress has been made in the field
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of anesthesia of patients with diffuse non-toxic and nodular goitre, it is observed that
there are complications during the operation and in the postoperative period with
possible blood circulation disorders. Detection of obvious changes in the
cardiovascular system reduces the effectiveness of surgical treatment. According to the
research of Russian scientists, postoperative complications of patients with such
pathology were 1-4% [2], according to the data of foreign researchers, 5-10% [1].
There are no clearly developed data on diffuse non-toxic and nodular goitre in the
preoperative period. It is known that many complications were observed in the period
before receiving iodine, that is, when the operation was performed without special
preparation, during the operation and in the postoperative period [5]. Combined
preoperative preparation has been used for many years, resulting in a significant
reduction in early postoperative complications. Complications observed as a result of
the use of thyrostatic drugs in patients with diffuse toxic goiter: increased blood
pressure, monitoring of arrhythmias, use of iodine therapy and antiarrhythmic drugs,
as well as cardiac glycosides to prevent excessive bleeding [7]. On the other hand,
preoperative preparation is important for surgical treatment of patients with diffuse
nontoxic and nodular goiter. Due to the high risk of developing postoperative
complications in patients with partial symptoms of thyrotoxicosis who are not properly
prepared, it is dangerous to operate on this group of patients. Proper systematic
preoperative preparation reduces the likelihood of postoperative complications.
Purpose of work
Analysis of preoperative preparation methods in patients with thyroid diseases
(diffuse nontoxic and nodular goiter) and evaluation of their effectiveness.
Inspection materials and methods
The study was conducted in the departments of surgery, anesthesiology and
resuscitation of the multidisciplinary clinic of the Samarkand State Medical University.
110 patients were taken for examination: shortness of breath due to the size of the
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thyroid gland, which was present in all patients, MNS function (responsibility,
headache, decreased work ability, sleep disturbance), cardiovascular system
(palpitations, rapid heart rate, expansion of heart borders) signs of deterioration, signs
of diffuse damage to the myocardium (on ECG), as well as damage to the digestive
system changes such as weight loss, increased or decreased appetite, etc. All patients
underwent complete clinical and diagnostic examination, necessary paraclinical and
biochemical examinations. All patients underwent thyroid palpation, thyroid
ultrasound examination (UTT), and general clinical examinations that determined the
amount of thyrotropin hormone. The examined patients were divided into 2 groups: 55
patients were included in the main group, and in addition to traditional drugs, stress
protector and adaptogenic drug: adaptol 500mg 2 times a day and cardioselective beta
1
-adrenoblocker : bisoprolol 10mg a day were added to the complex preparation before
surgery; 55 patients were included in the control group , and they were pre-operatively
prepared with traditional preparations (cocarboxylase, panangin, ascorbic acid, riboxin
in generally acceptable doses). Systolic arterial blood pressure (sysAKB), diastolic
arterial blood pressure (diastAKB), mean arterial pressure (UAB) and heart rate (UUS)
in both groups of patients in 5 stages: 1st stage - at the hospital, 2nd stage - 2 after
surgery day before, 3- 1 day before surgery, 4- after premedication, 5- 1- after surgery
inspections and observations were carried out during the day.
Results and their discussion
Our investigations showed that in both groups, no distinguishing signs were
detected in hemodynamics during hospitalization. When observing the changes in
hemodynamics step by step, it was observed that in the control group patients, in the
preoperative period, before the start of anesthesia induction, sAQB, dAQB, UAB and
YuUS increased compared to the first stage.
Hemodynamic changes evaluating the patient's general condition are presented
in the table (see Table 1). In the 1st stage, the hemodynamic indicators in groups 1 and
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2 were around the same indicators, which can be attributed to the stress of patients
arriving at the hospital.
In the 2nd stage, as a result of the pre-operative preparation process, the patients
in the groups were observed to have differences in hemodynamic indicators. That is,
group 1 sys.AQB up to 7-8%, dias.AQB up to 6-7%, medium.AQB up to 7-8%, YuKS
7 It was observed to decrease to %. In group 2, these indicators were around 2-3%.
This shows the effect of pre-operative preparatory measures and moderation of the
patient's psycho-emotional condition.
In the 3rd stage, hemodynamic parameters in group 1: sys.AQB (mm.cm.ust.)
decreased to almost normal values 120.9 ± 1.3, dias.AQB 87.1 ± 0.7, average.AQB
98.4 ± 1, 0, YuUS ta/min is equal to 78.5 ± 0.8. 2nd group.AQB138.9±1.3,
dias.AQB97.1±0.9, average.AQB111.3±1.2, YuUS ta/min was 84.3±0.7. In the 5th
stage, in the 1st group, sys.AQB was 111.3 ± 1.2, dias.AQB was 72.4 ± 0.8,
average.AQB was 85.4 ± 0.8, YuKS was 76.6 ± 0.7. In group 2, sys.AQB128.3 ± 1.2,
dias.AQB86.4 ± 0.9, average.AQB100.4 ± 0.9, YuUS ta/min was 85.3 ± 0.8. The
changes in the next stages showed the hemodynamics and stress hormones in the mine
to be at the same level , and ensured that the pre-operative preparation and the
anesthesia process went without complications.
The studied hemodynamic indicators in patients with thyroid disease of the 1st
group remained stable until the 5th stage. In particular, in the patients of group 1, the
normalization of AQB, stabilization of the number of heart contractions was observed,
and it was determined that his general condition changed in a positive direction. An
increase in hemodynamic indicators was observed in the patients of the 2nd group.
Glucose and cortisol, which examined the patient's plasma, as a result of tests,
the amount of glucose and cortisol remained almost unchanged in the main group of
patients. It showed that the patients used complex drugs in the pre-operative
preparation and adequate anesthesia during the operation. In the second group of
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patients, it was shown that the amount of glucose and cortisol in the blood increased in
the period after the operation, indicating the low effectiveness of pre-operative
preparation and the lack of anesthesia.
Hemodynamic changes in the main stages of the perioperative period in patients
operated on with thyroid disease
Table #1
Check
buttons
sis. AQB
dias.AQB medium.
AQB
Yu U S
ta/min
The
amount
of
glucose
in the
deposit
( mmol
/l
Cortis
ol
(
μmol
/l)
1 gr
ou
p
2
gro
up
s
1 gr
ou
p
2
gro
up
s
1 gr
ou
p
2
gro
up
s
1
gr
ou
p
2
gro
up
s
1 gr
ou
p
2
gro
up
s
1 gr
ou
p
2
gro
up
s
1st step -
when
stationary
157.
5 ±
1.6
156.
3 ±
1.3
107
.5 ±
1.0
105.
5 ±
1.3
124.
2 ±
1.0
122.
4 ±
1.1
89.
7 ±
1.1
94.6
±
1.2
4.5
±0.
6
4.
8
±0
.7
0.
6
9
±
0.
4
0.
4
9
±
0.
1
2nd dose - 2
days before
surgery
137.
2 ±
1.6 r
>0
.05
145.
2±1.
6 p>
0.05
95.
3 ±
0.9r
>
102.
3 ±
0.8r
>
0.05
109.
3 ±
0.8r
>
0.05
116.
6 ±
0.9r
>
0.05
81.
8 ±
0.9r
>
88.5
±
0.8r
>
0.1
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0.0
5
0.0
5
3- 1 day
before
the
operation
120.
9 ±
1.3
138.
9 ±
1.3
87.
1 ±
0.7
97.1
± 0.9
98.4
± 1.0
111.
3 ±
1.2
78.
5 ±
0.8
84.3
±
0.7
4-
after
premedicatio
n
118.
5 ±
1.3
r >
0.05
r 1>
0.05
135.
5 ±
1.3
r >
0.05
r 1>
0.05
79.
1 ±
0.7
p <
0.0
5
r 1>
0.0
5
89.1
± 0.8
r >
0.05
r 1>
0.05
92.2
± 0.8
p <
0.05
r 1>
0.1
104.
5 ±
0.9
p <
0.05
r 1>
0.1
75.
3 ±
0.7
p <
0.0
5
r 1>
0.0
5
82.4
±
0.8
p <
0.05
r 1>
0.05
day
after
surgery
111.
3 ±
1.2
r >
0.00
1
r 1>
0.05
128.
3 ±
1.2
r >
0.00
1
r 1>
0.05
72.
4 ±
0.8
p <
0.0
01
r 1>
0.2
86.4
± 0.9
p <
0.00
1
r 1>
0.2
85.4
± 0.8
p <
0.01
r 1>
0.1
100.
4 ±
0.9
p <
0.01
r 1>
0.1
76.
6 ±
0.7
p <
0.0
5
r 1>
0.3
85.3
±
0.8
p <
0.05
r 1>
0.3
5.6
±0.
3
8.
5
±0
.4
0.
71
±
0.
2
0.
8
9
±
0.
8
Izo h :r is the first stage check with in comparison reliability k ' indicator ;
r1- previous stage check with in comparison reliability index k ' .
Checked indicators from surgery previous from indicators a convincing
difference was made . Main in the group in patients heart stroke count and AQB are
normal to indicators decline it 's been a long time . From the operation next early in the
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above period kursatki to the norm near the arrival it 's been a long time . Patient pay
attention to the presence of headache , pain in the heart area , no increase in blood
pressure .
Conclusion .
Thyroid disease ( diffuse non-toxic and knotty this q o q i) b died
patients operation preparedness methods analytical showed that to them from surgery
in the previous comprehensive preparation traditional preparations with one A stress
protector and adaptogenic drug : adaptol and Cardioselective beta
1
- adrenoblocker :
bisoprolol like drug the use of tools from surgery previous and operation and in q ti
observation possible hemodynamic changes eliminate to ask help gives and from
surgery later and q in t development may be dead complications prevention takes
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