BACKGROUND:Cancer patients frequently visit the emergency department (ED) with various symptoms of cancer. The purpose of this study was to determine the clinical characteristics and 1-year survival rate of cancer patients in the ED of a university hospital. METHODS:We conducted a retrospective review of 408 cancer patients who visited the ED between January 2011 and December 2011. Patient information on demographics, chief complaints, findings, and survival was gathered from the hospital registry and corresponding health administration. RESULTS:The study included 240 (58.8％) males and 168 (41.2％) females with a median age of 57.9 years (range 19–87). Regarding cancer staging, 266 patients (65.3％) had metastatic disease and 142 (34.7％) had local and loco-regional disease. The hospitalization rate was 59.6％. The most common symptoms were shortness of breath (23.2％), pain (17.8％), fever (14.2％), and nausea/vomiting (14.4％). The most common cancer sites were the lung (32.5％), gastrointestinal system (25.4％), and breast (9.3％). The initial evaluation determined progressive disease (42.4％), chemotherapy effects (20.7％), infections (17.2％), radiotherapy effects (4.7％), extravasation (1.8％), anemia (1.4％), and unknown (11.3％). During follow up, 191 (46.8％) patients died after admission to the ED. The 1-year overallsurvival of allpatients was 7.3 months. CONCLUSIONS:Symptom management in cancer patients is a complex multifaceted concern for the emergency physician. Because of the increasing prevalence of cancer patients, emergency physicians should develop consensus algorithms in collaboration with the relevant disciplines to manage the commonly encountered problems.

PURPOSE: The use of nondepolarizing neuromuscular blocking agents (NMBAs) may affect intraoperative neuromonitoring (IONM) during anesthesia used during thyroid and parathyroid surgery. METHODS: The use of sugammadex was evaluated in a prospective clinical study during thyroid surgery. Between July 2018 and January 2019, 129 patients were prospectively randomized to either the sugammadex group (group B) or the control group (group A). Group A patients underwent standardized IONM during thyroidectomy, while group B patients used an NMBA-reversal protocol comprised of rocuronium (0.6 mg/kg) in anesthesia induction and sugammadex (2 mg/kg) after first vagal stimulation (V0). A peripheral nerve stimulator was used to monitor the neuromuscular transmission. RESULTS: In our clinical study, it took 26.07 ± 3.26 and 50.0 ± 8.46 minutes to reach 100% recovery of laryngeal electromyography at injection of the sugammadex group (2 mg/kg) and the control group, respectively (P < 0.001). The train-of-four ratio recovered from 0 to >0.9 within 4 minutes after administering 2 mg/kg of sugammadex at the beginning of resection. Surgery time was significantly shorter in group B than in group A (P < 0.001). Transient recurrent laryngeal nerve (RLN) paralysis was detected in 4 patients from group A and in 3 patients from group B (P = 0.681). There was no permanent RLN paralysis in the 2 groups. CONCLUSION: Our clinical study showed that sugammadex effectively and rapidly improved the inhibition of neuromuscular function induced by rocuronium. The implementation of the nondepolarizing neuromuscular block recovery protocol may lead to tracheal intubation as well as favorable conditions for IONM in thyroid surgery.
Anesthesia ; Clinical Study ; Electromyography ; Humans ; Intubation ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Paralysis ; Peripheral Nerves ; Prospective Studies ; Recurrent Laryngeal Nerve ; Thyroid Gland ; Thyroidectomy