Perioperative airway management in the case of severe tracheal narrowing and deviation caused by multinodular goitre: case report

Journal of Anesthesiology & Clinical Science

Abstract Background: Worldwide, endemic goiter is prevalent and is often caused by inadequate iodine intake. On the other hand, iodine may not be deficient in some parts of the world, yet goiters still occur due to the presence of goitrogens in the diet which eventually leads to the thyroid gland enlargement by interfering with normal production of thyroid hormone. In Sub-Saharan Africa, iodine deficiency is widespread and is of public health concern. However, limited diagnostic and management possibilities in this area often result in long standing goiters which eventually develops into large goiters that consequently compress the airway. Case presentation: A 74-year-old woman diagnosed with multi nodular goiter was anesthetized for sub-total thyroidectomy. The goiter was large and multi nodular in nature, pushing the trachea to the left side of the neck. This subsequently led to tracheal compression, narrowing, and deviation. During induction of general anesthesia, intubation using flexible fibreoptic bronchoscopy techniques was impossible. Tracheal intubation was achieved via tracheostomy using size 7-mm cuffed endotracheal tube. We present this case at length and describe how the airway was secured during and after surgery. Conclusion: Airway management for thyroidectomy involving large goiters with severely compromised airways could be considered for tracheostomy in most hospitals in developing countries where advanced anesthesia equipment are not readily available. Key words: Multinodular goiter, airway, thyroidectomy, intubation, tracheostomy
April 2014
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