None listed
Conditions
Brief summary
The head and neck are positioned with varying degrees of extension during thyroidectomy. The conventional approach is to place a shoulder roll behind the patient’s shoulders to extend the neck before surgical incision. Sometimes, a special silicone pillow which is called “Dunhill pillow” is used to support the head, neck and shoulders. However, hyperextension of the neck was reported to be associated with some series complications such asocclusion in the carotid and vertebral arteries. Therefore, the position may result in impaired postoperative cognitive functions related to decreased arterial blood flow during thyroidectomy surgery.In the current study, Our primary hypothesis is that patients positioned with Dunhill pillow will have lower MoCA scores at the postoperative 6th hour than the patients positioned with a shoulder roll. Our secondary hypothesis is that the mean blood flow in the carotid artery of the patients in Dunhill pillow group will be lower than the shoulder roll group at the end of the operation. Another secondary hypothesis is that the degree of head extension will be higher in the Dunhill pillow group than the shoulder roll group.
Interventions
The cognitive functions of the patients will be evaluated with Montreal cognitive assessment test (MoCA) at the day before surgery. Before induction of general anesthesia, an anesthesiologist will perform doppler ultrasonographic measurements of each patient (T0) over carotid artery. Then the patients will be randomly allocated into two groups. Patients will be positioned with a special pillow called Dunhill pillow in Group 1. Dunhill pillow is a jelly pillow designed to support shoulder blades
The cognitive functions of the patients will be evaluated with Montreal cognitive assessment test (MoCA) at the day before surgery. Before induction of general anesthesia, an anesthesiologist will perform doppler ultrasonographic measurements of each patient (T0) over carotid artery. Then the patients will be randomly allocated into two groups. Patients will be positioned with a special pillow called Dunhill pillow in Group 1. Dunhill pillow is a jelly pillow designed to support shoulder blades of a patient where extension of the neck is needed. A standard shoulder roll will be placed under the shoulders of patients in Group 2. The doppler ultrasonographic evaluation will be repeated after the induction(T1) , after positioning of the patient (T2) and at the end of the surgery (T3). The cognitive functions of the patients will be re-evaluated with MoCA at the postoperative 6th hour.
Sponsors
Basak Altiparmak
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
The patients with American Society of Anesthesiologists (ASA) physical status I-II, between 18-65 years old and scheduled for an elective thyroidectomy surgery
Exclusion criteria
Patients with preoperative Montreal cognitive assessment test score under 24, known psychological disorder, inability of the patient to communicate, hemoglobin level lower than 8 mg dL-1, known hyperlipidemia, hypertension or diabetes mellitus, cerebrovascular disorders, BMI over 40 kg m-2, surgical time shorter than 90 min or longer than 120 minutes
Outcome results
None listed