Neck extension during thyroidectomy: effects on early postoperative cognitive function and optic nerve sheath diameter- a randomized controlled trial
Bibliographic record
Abstract
BACKGROUND: During thyroidectomy, patients are commonly positioned with neck extension using a shoulder roll. Excessive extension may impair arterial and venous outflow, compromise cerebral perfusion, and elevate intracranial pressure, potentially leading to postoperative cognitive impairment. This study investigated the effect of shoulder-roll-assisted neck extension on cognitive outcomes and on optic nerve sheath diameter (ONSD). METHODS: After tracheal intubation, patients were randomly assigned to either a shoulder roll group or a control group without a roll. The primary outcome was the Montreal Cognitive Assessment (MoCA) score at 6 h postoperatively. Secondary outcomes included ONSD and the degree of neck extension. RESULTS: Postoperative MoCA scores were significantly lower in the shoulder roll group (20.56 ± 2.71) compared with the control group (23.57 ± 2.37; P < 0.001). ONSD increased over time in both groups (P < 0.001), but repeated-measures analysis showed no significant difference between groups (P = 0.333). Neck extension was greater in the shoulder roll group (126 ± 4.36°) than in the control group (116 ± 3.74°; P < 0.001). CONCLUSIONS: Shoulder roll positioning during thyroidectomy was associated with lower MoCA scores at 6 h, indicating mild postoperative cognitive decline. Although greater neck extension was observed, ONSD values did not significantly differ between groups. TRIAL REGISTRATION: Muğla Sıtkı Koçman University Clinical Research Ethics Committee (approval number T-XII, June 17, 2019). Australian New Zealand Clinical Trials Registry (registration number: ACTRN12619001066178, date of registration: July 31, 2019).
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".