Title: Peri-operative Management of Huge Goitre with Compromised Airway

Authors: Dr Kartik Syal, Dr Ankita Chandel, Dr Manjit Singh Kanwar

 DOI: https://dx.doi.org/10.18535/jmscr/v8i2.75

Abstract

Goitre has always remained a known risk factor for difficult airway. The never ending challenges are being faced by an anaesthesiologist all through the pre-operative, intra-operative and post-operative period. We report the anaesthetic management of world’s second largest and India’s largest goitre with tracheal narrowing and deviation which further required re-exploration for bleeding from the surgical site. Though awake fiberoptic intubation remains procedure of choice in this scenario but carries failure rate. Also availability of flexible fiberoscope is still limited, mandating use of alternate techniques which sometimes provide better alternative to failed fiberoptic intubation.

References

  1. Amathieu R, Smail N, Catineau J, et al. Difficult intubation in thyroid surgery: myth or reality. Anesth Analg 2006; 103:965-8.
  2. Cook TM, Scott S, Mihai. Litigation following airway and respiratory-related anaesthetic morbidity and mortality: an analysis of claims against the NHS in England 1995–2007. Anaesthesia 2010;65:556-63.
  3. Cook TM, Woodall N, Frerk C. Major complications of airway management in the UK: results of the 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1 Anaesthesia. Br J Anaesth 2011;106:617-31.
  4. Ali Dabbagh et al. A rapidly enlarging neck mass. The role of sitting position In Fiberopticbronchoscopy. AnesthAnalg 2008;107:1627-9
  5. M. Woodall, R. J. Harwood and G. L. Barker Complications of awake fibreoptic intubation without sedation in 200 healthy anaesthetists attending a training course British Journal of Anaesthesia 100 (6): 850–5 (2008).
  6. Claydon PJ, Cressey D. Complete airway obstruction during awake fibreoptic intubation. Anaesthesia 1997;52:1120-1.
  7. Ho AMH, Chung DC, Karmakar MK, Gomersall CD, Peng Z, Tay BA. Dynamic airflow limitation after topical anaesthesia of the upper airway. Anaesth Intensive Care 2006;34:211-5.
  8. Kim TI, Lim HJ, Chang SH, Kim NS. Intraoperative carotid sinus hypersensitivity and postoperative complication of radical neck dissection retrospective study. Korean J Crit Care Med. 1998;13:49–54.
  9. Czyhlarz E. Ueber ein pulsiondivertikel der trachea mit bemerkungen uber das verhalten der elastichen fasern an normalen tracheen und bronchein [in German]. Zentralbl Allg Pathol 1897;18:721-8.
  10. Tripathi M. Goiter and Airway Control. World J Endoc Surg 2010;2(1):9-16.
  11. Mayilvaganan S, Agarwal A. Management of post-Thyroidectomy Tracheomalacia. World J Endoc Surg 2014;6(2):96-8.
  12. Singh B, Lucente FE, Shaha AR. Substernal goiter: a clinical review. Am J Otolaryngol 1994;15:409.

Corresponding Author

Dr Ankita Chandel

Ex registrar, Department of Anaesthesia IGMC, Shimla