The use of drains in thyroid surgery.

OBJECTIVE: To evaluate the necessity and benefits of the use of drains and their limitations in thyroidectomy and assess their relationship with cost of surgery and hospital stay. METHODS: We conducted a prospective randomised study on 67 patients divided into two groups. A consisted of 35 patients with drain and B, 32 patients without drain between January 2005 and June 2007. All had subtotal thyroidectomy and the technique and method of closure were the same. No anticoagulant was used and the clotting profiles were within normal range in the two groups. RESULTS: The sixty seven patients recruited for the study were made up of 60 females (89.6%) and 7 males (10.4%). The mean age for group A was 50.14 +/- 10.7 years, group B was 51.97 +/- 9.5 years. The P value for the mean ages of the two groups is 0.464 (p=0.05,t=3.98).There was no blood transfusion. Three patients developed features of respiratory obstruction (respiratory distress and stridor) -the first 2, one from each group was as a result of laryngeal oedema from trauma of difficult intubation. The third was from group B, as a result of hemorrhage and haematoma collection (she was one of the controlled thyrotoxic patients). Two patients (5.7%) developed wound infections in group A, which increased morbidity, hospital bill and prolonged hospital stay as compared to group B. The highest volume of drainage of 35ml was from a woman with a big goiter (120g). Average drainage was 17.7 +/- 6.9ml. CONCLUSION: The use of drains is not necessary in all cases of thyroidectomy but for cases with large cavity post extraction and copious oozing in vascular glands. Some of the limitations to the use of drains are infections, this can prolong hospital stay and thereby increase hospital bill.

General and regional anaesthesia for thyroidectomy in rural/semi-urban Nigerian centres.

OBJECTIVE: To evaluate the feasibility and benefits of regional anaesthesia (RA) for thyroidectomy in rural/semi-urban centres. DESIGN: A prospective study. SETTINGS: Missionary Hospital Saki, Nigeria and Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. SUBJECTS: One hundred and seventy five patients with goitre. RESULTS: The average time for the anaesthetists to put patients to sleep was 4.06 +/- 1.02 minutes, while it took 17.8 +/- 2.9 minutes to give the regional block. Post operative laryngeal complications in RA group were very minimal, while in general anaesthesia (GA) group, there were significant complications in 32 (36%) patients laryngeal oedema 15 (17%), erosions in 10 (11%) and ulcer in seven (8%). Cost of surgery in GA was thrice as much as in RA group. Thirty one (35%) with GA had steam inhalation for sore throat. It was possible to converse (laryngeal nerve monitoring) with the patient during operation but not possible with GA group. There was early discharge of patients in RA group. CONCLUSION: Regional/local anaesthesia is feasible for some cases of thyroidectomy with a lot of advantages and specifically allows surgeons to converse with the patients during operation-direct laryngeal and other nerve monitoring. Despite advancement in cuff design a lot of lesions still occur from endotracheal intubations.