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Strong A, Fletcher C, Budge M, Hastings S, Prasad J, Grodski S, Serpell JW, Lee JC. The use of extracorporeal membrane oxygenation for elective removal of a massive goitre causing a potentially difficult airway. ANZ J Surg 2023; 93:2758-2759. [PMID: 37475519 DOI: 10.1111/ans.18598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/09/2023] [Accepted: 06/28/2023] [Indexed: 07/22/2023]
Affiliation(s)
- April Strong
- Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Calvin Fletcher
- Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Melissa Budge
- Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Stuart Hastings
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Jessica Prasad
- Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Simon Grodski
- Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Jonathan W Serpell
- Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - James C Lee
- Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Kim G, Kim YY, Heo HJ, Park J. Remimazolam sedation with regional anesthesia in difficult airway due to huge thyroid goiter: A case report. Medicine (Baltimore) 2023; 102:e35497. [PMID: 37861519 PMCID: PMC10589527 DOI: 10.1097/md.0000000000035497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023] Open
Abstract
RATIONALE Remimazolam, a novel benzodiazepine, is known to have less respiratory depression compared to other anesthetic agents, and it also has a reversal agent that can be used in emergency situations. Remimazolam with these characteristics can be usefully utilized in the anesthetic management of patients with difficult airway. PATIENT CONCERNS A 78-year-old female patient was scheduled proximal humerus fracture surgery. The patient occasionally complained dyspnea and had multiple comorbidities including thyroid goiter, dementia, and delirium. DIAGNOSES The patient had a large thyroid goiter compressing and deviating the trachea. A short neck with increased circumference was confirmed. A difficult airway was anticipated in the preanesthetic evaluation. INTERVENTIONS Sedation with remimazolam followed by regional anesthesia was performed for the surgery. OUTCOMES The surgery was completed without complications. The patient recovered and was discharged on 15th postoperative days. LESSONS The use of remimazolam for sedation may be an appropriate option in the anesthetic management of patients with difficult airway.
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Affiliation(s)
- Gwanbeom Kim
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Jeollabuk-Do, Korea
| | - Yu Yil Kim
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Jeollabuk-Do, Korea
| | - Hyun Joo Heo
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Jeollabuk-Do, Korea
| | - Junyoung Park
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Jeollabuk-Do, Korea
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Kim JY, Yeom JY, Youn SJ, Lee JE, Oh JY, Byun SH. Fiberoptic-guided nerve integrity monitoring tube intubation assisted by video-laryngoscope with external laryngeal manipulation in a patient with anteriorly displaced larynx due to huge goiter with retropharyngeal involvement: A case report. Medicine (Baltimore) 2022; 101:e29041. [PMID: 35451415 PMCID: PMC8913080 DOI: 10.1097/md.0000000000029041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/23/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Goiter, an abnormal enlargement of the thyroid gland, can induce airway distortion or tracheal compression. Airway management can be challenging for anesthesiologists, depending on the location and size of the mass as well as the patient's airway conditions, although it is reported that most cases can easily be managed by oral intubation. PATIENT CONCERNS A 61-year-old female patient who had planned for a total thyroidectomy due to a huge goiter was intubated with nerve integrity monitoring (NIM) tubes, using video laryngoscopy (VL) and oral fiberoptic bronchoscopy (FOB) alone. The respective attempts initially failed. DIAGNOSIS The patient's thyroid mass extended from the C3 cervical spine level to the T1 thoracic spine level with retropharyngeal involvement, causing an upper airway anatomical alteration that made intubation difficult. FOB manipulation was challenging due to the acute angulation of the laryngeal inlet and the tongue and the consequent interruption by the epiglottis. There was resistance to tube introduction, despite counterclockwise rotation of the NIM tube, due to acute angulation of the larynx and circumferential narrowing of the oropharyngeal and supraglottic space. INTERVENTIONS In the first step of FOB-guided intubation, external laryngeal manipulation (ELM) was performed to improve the angle of the glottic opening and to elevate epiglottis tip. This allowed for FOB introduction into the trachea. VL was then performed transorally to elevate the tongue base and increase space, using the blade. ELM was applied simultaneously to move the glottis lower, thereby reducing the angle of the tube passage. OUTCOMES The NIM tube was successfully introduced into the trachea with counterclockwise rotation in FOB-guided intubation. LESSONS The combination of techniques using basic and popular devices and maneuvers, such as ELM and VL, may be useful for the successful management of difficult airways related to retropharyngeal goiter, without the need for surgical airway.
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Affiliation(s)
- Ji-Yoon Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Ji-Yong Yeom
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Si-Jeong Youn
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jeong-Eun Lee
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jin-Young Oh
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sung-Hye Byun
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Tasche KK, Dorneden AM, Swift WM, Boyd NH, Shonka DC, Pagedar NA. Airway Management in Substernal Goiter Surgery. Ann Otol Rhinol Laryngol 2021:34894211014794. [PMID: 34032125 DOI: 10.1177/00034894211014794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE(S) To review the experience of 3 hospitals with airway management during surgery for substernal goiter and identify preoperative factors that predict the need for advanced airway management techniques. METHODS A retrospective chart review between 2009 and 2017 of patients with substernal goiter treated surgically at 1 of 3 hospitals was performed. RESULTS Of the 179 patients included in the study, 114 (63.7%) were female, the mean age was 55.1 years (range 20-87). Direct laryngoscopy or videolaryngoscopy was successful in 162 patients (90.5%), with fiberoptic intubation used for the remaining 17 patients. Thirty-one patients (17.4%) required >1 intubation attempt; these patients had larger thyroids (201.3 g, 95% CI 155.3-247.2 g) than those intubated with 1 attempt (144.7 g, 95% CI 127.4-161.9 g, P = .009). Those who required >1 attempt had higher BMI (38.3, 95% CI 34.0-42.6 vs. 32.9, 95% CI 31.5-34.3, P = .02). Mallampati score was found to be a predictor of >1 attempt, though tracheal compression and tracheal shift were not found to be predictors of >1 attempt, nor was the lowest thyroid extent. BMI was the only independent factor on multivariable logistic regression of needing >1 attempt (odds ratio 1.056, 95% CI 1.011-1.103, P = .015). CONCLUSIONS The majority of patients undergoing surgery for substernal goiter can be intubated routinely without the need for fiberoptic intubation. Thyroid-specific factors such as lowest thyroid extent and mass effect of the gland on the trachea do not appear to be associated with difficult intubation, whereas classic patient factors associated with difficulty intubation are. LEVEL OF EVIDENCE VI.
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Affiliation(s)
- Kendall K Tasche
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Ashley M Dorneden
- Division of Otolaryngology, Department of Surgery, University of New Mexico Health Sciences, Albuquerque, NM, USA
| | - William M Swift
- Department of Otolaryngology-Head & Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Nathan H Boyd
- Division of Otolaryngology, Department of Surgery, University of New Mexico Health Sciences, Albuquerque, NM, USA
| | - David C Shonka
- Department of Otolaryngology-Head & Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Nitin A Pagedar
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
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Renjith I, Revathi R. Airway obstruction by subcutaneous tissues growing into tracheal lumen below tracheostomy stoma: A case report. BALI JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.4103/bjoa.bjoa_45_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Pan Y, Chen C, Yu L, Zhu S, Zheng Y. Airway Management of Retrosternal Goiters in 22 Cases in a Tertiary Referral Center. Ther Clin Risk Manag 2020; 16:1267-1273. [PMID: 33376336 PMCID: PMC7764631 DOI: 10.2147/tcrm.s281709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background The present study aimed to investigate the incidence and extent of difficult airway management in patients with massive retrosternal goiter. Design An 8-year retrospective analysis was performed to identify patients who underwent massive retrosternal thyroidectomy. A total of 22 cases were identified as giant retrosternal goiter, followed by a review of each patient’s preoperative computerized tomography imaging. Interventions There were no cases of failed intubation. Twenty patients underwent uneventful tracheal intubation using direct laryngoscopy or Glidescope. Thirteen patients received a muscle relaxant intravenously, and two patients were induced with sevoflurane. Five patients underwent awake tracheal intubation, including awake fiberoptic intubation in three patients. Before entering the operating theatre, the remaining two patients underwent oral tracheal intubation with Glidescope in the emergency department. Results Two patients had tracheal intubation before they entered the operating theatre. Once entering vocal cords, tracheal intubation can pass beyond the site of the tracheal obstruction without difficulty. One patient died because of serious perioperative bleeding owing to the adhesion between the retrosternal goiter and large vessel within the thoracic cavity. One patient experienced dyspnea after extubation and was intubated again. Conclusion Intravenous induction of muscle relaxant using laryngoscopy or Glidescope is feasible in patients with massive benign retrosternal goiter. The incidence of difficult intubation and postoperative tracheomalacia is likely too rare. Furthermore, perioperative bleeding and postoperative airway complication seem frequent.
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Affiliation(s)
- Yuanming Pan
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, People's Republic of China
| | - Chaoqin Chen
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, People's Republic of China
| | - Lingya Yu
- Department of Radiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, People's Republic of China
| | - Shengmei Zhu
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, People's Republic of China
| | - Yueying Zheng
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, People's Republic of China
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Essig GF, Niermeyer WL, Essandoh M, Dewhirst E, Gerlach RM, Gonzalez LS, Chaney MA. Averting Risk of Airway Loss During Surgical Management of Retrosternal Goiters. J Cardiothorac Vasc Anesth 2020; 34:2260-2268. [DOI: 10.1053/j.jvca.2020.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 12/17/2022]
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Lee S, Youn S, Chung W, Shin Y, Lim C. Extracorporeal membrane oxygenation for surgery to remove a huge goiter causing tracheal obstruction. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.05019-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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9
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Kim SM, Kim HJ. Successful advancement of endotracheal tube with combined fiberoptic bronchoscopy and videolaryngoscopy in a patient with a huge goiter. SAGE Open Med Case Rep 2020; 8:2050313X20923232. [PMID: 32577281 PMCID: PMC7290263 DOI: 10.1177/2050313x20923232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 04/08/2020] [Indexed: 12/26/2022] Open
Abstract
If the presence of a goiter causes airway deformities in the supraglottic and infraglottic areas, difficult airway should be considered and airway evaluation including physical examination, radiologic studies, and indirect laryngoscopy should be preoperatively performed to determine the airway management plan. Various methods such as direct laryngoscopy, videolaryngoscopy, awake fiberoptic intubation, tracheostomy, and extracorporeal membrane oxygenation support have been reported to secure the airway. In most previously reported goiter cases, the upper airway patency was well maintained and the endotracheal tube was easily passed even when there was severe tracheal narrowing and deviation. We describe a case of successful combined use of videolaryngoscopy and fiberoptic bronchoscopy for advancement of an endotracheal tube through a narrow trachea due to the presence of a huge goiter.
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Affiliation(s)
- Sung Mi Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Joo Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg 2020; 271:e21-e93. [PMID: 32079830 DOI: 10.1097/sla.0000000000003580] [Citation(s) in RCA: 238] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy. BACKGROUND Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US. METHODS The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. RESULTS These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. CONCLUSIONS Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.
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11
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Pisano G, Canu GL, Erdas E, Medas F, Calò PG. Tracheostomy after total thyroidectomy: indications and results in a series of 3214 operations. MINERVA CHIR 2019; 74:277-278. [PMID: 30665291 DOI: 10.23736/s0026-4733.19.07907-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Giuseppe Pisano
- Department of Surgical Sciences, Policlinic of Monserrato, University of Cagliari, Monserrato, Cagliari, Italy -
| | - Gian L Canu
- Department of Surgical Sciences, Policlinic of Monserrato, University of Cagliari, Monserrato, Cagliari, Italy
| | - Enrico Erdas
- Department of Surgical Sciences, Policlinic of Monserrato, University of Cagliari, Monserrato, Cagliari, Italy
| | - Fabio Medas
- Department of Surgical Sciences, Policlinic of Monserrato, University of Cagliari, Monserrato, Cagliari, Italy
| | - Pietro G Calò
- Department of Surgical Sciences, Policlinic of Monserrato, University of Cagliari, Monserrato, Cagliari, Italy
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Lee PKG, Booth AWG, Lloyd BS. When Cardiopulmonary Bypass Is Not An Option—A Case of Massive Retrosternal Goiter With Severe Tracheal Compression in an Extremely Obese Patient. J Cardiothorac Vasc Anesth 2018; 32:956-959. [DOI: 10.1053/j.jvca.2017.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Indexed: 12/17/2022]
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Sorensen JR, Lauridsen JF, Døssing H, Nguyen N, Hegedüs L, Bonnema SJ, Godballe C. Thyroidectomy Improves Tracheal Anatomy and Airflow in Patients with Nodular Goiter: A Prospective Cohort Study. Eur Thyroid J 2017; 6:307-314. [PMID: 29234624 PMCID: PMC5704720 DOI: 10.1159/000480348] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/14/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE A large goiter may cause compression of the trachea. The aim of this study was to investigate the impact of thyroidectomy on tracheal anatomy and airflow and to correlate this with changes in health-related quality of life (HRQoL) in patients with benign nodular goiter. METHODS Magnetic resonance images of the neck and respiratory flow-volume curves, including both inspiration and expiration, were performed prior to and 6 months following surgery. HRQoL was measured by selected scales from the thyroid-specific patient-reported outcome (ThyPRO). Cohen's effect size (ES) was calculated as mean change divided by standard deviation at baseline. ES of 0.2-0.5 were defined as small, 0.5-0.8 as moderate, and values >0.8 as large. RESULTS Sixty-five patients completed all examinations. Median goiter volume was 58 mL (range, 14-642 mL) before surgery with surgical removal of a median of 43 g (range, 8-607 g). Six months after surgery, tracheal narrowing and deviation were diminished by a median of 26% (ES = 0.67, p < 0.001) and 33% (ES = 0.61, p < 0.001), respectively. Correspondingly, each 10% decrease in goiter volume resulted in 1.0% less tracheal narrowing (p < 0.001). Concomitantly, a small improvement was seen in forced inspiratory flow at 50% of forced vital capacity (ES = 0.32, p < 0.001). A reduction in tracheal narrowing was associated with improvements in the Impaired Daily Life scale (0.33 points per 1% decrease in tracheal narrowing, p = 0.03) of the ThyPRO questionnaire. CONCLUSIONS In patients with symptomatic benign nodular goiter, thyroidectomy resulted in substantial improvements in tracheal anatomy and improvements in inspiratory flow, which were followed by gains in HRQoL. This information is pertinent when counseling patients before choice of treatment.
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Affiliation(s)
- Jesper Roed Sorensen
- Department of ORL Head and Neck Surgery, Odense University Hospital, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- *Jesper Roed Sorensen, MD, Department of ORL Head and Neck Surgery, Odense University Hospital, J.B. Winsløws Vej 4, DK-5000 Odense C (Denmark), E-Mail
| | | | - Helle Døssing
- Department of ORL Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | - Nina Nguyen
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Steen Joop Bonnema
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Christian Godballe
- Department of ORL Head and Neck Surgery, Odense University Hospital, Odense, Denmark
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Hohn A, Kauliņš T, Hinkelbein J, Kauliņa K, Kopp A, Russo SG, Kohlen S, Schröder S. Awake tracheotomy in a patient with stridor and dyspnoea caused by a sizeable malignant thyroid tumor: a case report and short review of the literature. Clin Case Rep 2017; 5:1891-1895. [PMID: 29152294 PMCID: PMC5676267 DOI: 10.1002/ccr3.1216] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/03/2017] [Accepted: 08/07/2017] [Indexed: 12/26/2022] Open
Abstract
Individual airway management is mandatory in patients with large goiters undergoing thyroid surgery. Preoperative endoscopic airway evaluation and imaging studies can support clinical decision making. Awake tracheotomy can be an effective and reasonable airway management strategy in such patients.
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Affiliation(s)
- Andreas Hohn
- Department of Anaesthesiology and Intensive Care Medicine University Hospital of Cologne Kerpener Str. 62 50937 Cologne Germany
| | - Tālis Kauliņš
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine, Pain Medicine Düren Hospital Roonstr. 30 52351 Düren Germany.,Faculty of Medicine University of Latvia Raina Blvd. 19LV 1586 Riga Latvia
| | - Jochen Hinkelbein
- Department of Anaesthesiology and Intensive Care Medicine University Hospital of Cologne Kerpener Str. 62 50937 Cologne Germany
| | - Krista Kauliņa
- Faculty of Medicine University of Latvia Raina Blvd. 19LV 1586 Riga Latvia
| | - Andreas Kopp
- Department of Radiology Düren Hospital Roonstr. 30 52351 Düren Germany
| | - Sebastian G Russo
- Department of Anaesthesiology HELIOS University Hospital Wuppertal University of Witten/Herdecke Heusnerstr. 40 42283 Wuppertal Germany
| | - Sigurd Kohlen
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine, Pain Medicine Düren Hospital Roonstr. 30 52351 Düren Germany
| | - Stefan Schröder
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine, Pain Medicine Düren Hospital Roonstr. 30 52351 Düren Germany
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Thomas CM, Mattingly JK, Hendrickse A, Song JI. Case Report of a Massive Retropharyngeal Goiter Resulting in Laryngeal Compression. ACTA ACUST UNITED AC 2017; 9:178-181. [PMID: 28542048 DOI: 10.1213/xaa.0000000000000560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This is a rare presentation of a morbidly obese male with a massive retropharyngeal goiter causing laryngeal compressive symptoms and unique airway management challenges. Flexible laryngoscopy revealed a retropharyngeal mass circumferentially compressing the oropharynx and supraglottis and preventing the visualization of the glottis. Awake tracheostomy was performed before total thyroidectomy. Airway compression from a goiter typically results from substernal extension, which usually does not cause difficulty with endotracheal intubation. Extensive retropharyngeal extension can cause supraglottic obstruction of the airway. In these cases, optimal management consists of a closely coordinated approach between anesthesia and surgery teams to establish a surgical airway.
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Affiliation(s)
- Carissa M Thomas
- From the Departments of *Otolaryngology-Head and Neck Surgery and †Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado
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Sajid B, Rekha K. Airway Management in Patients with Tracheal Compression Undergoing Thyroidectomy: A Retrospective Analysis. Anesth Essays Res 2017; 11:110-116. [PMID: 28298767 PMCID: PMC5341636 DOI: 10.4103/0259-1162.186608] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Airway management in large and retrosternal goiters with tracheal compression is often fraught with challenges and is a source of apprehension among anesthesiologists globally. Aims: In this study we attempt to delineate the preferred techniques of airway management of such cases in our institution and also to assess whether airway management was unnecessarily complicated. Setting and Design: Retrospective analysis. Materials and Methods: A retrospective review was conducted of thyroidectomies performed in our institution over a three year period from January 2013. Clinical, radiological, pathological, anesthetic and surgical data were obtained from hospital case records. Statistical Analysis: Qualitative data is represented as frequencies and percentages and quantitative data as mean and standard deviation. Results: Of 1861 thyroidectomies tracheal compression were present in 50 patients with minimum tracheal diameter ranging from 4-12mm (mean 7.84); with majority(95%) having a benign pathology. Critical tracheal compression (≤5 mm) was observed in four patients. Conventional intravenous induction and intubation under muscle relaxant was performed in majority (64%) of these patients. The rest of the cases (n=18) were intubated while preserving spontaneous ventilation after induction. Primary technique of airway management was reported successful in all cases with no instances of difficult ventilation or intubation. Postoperative morbidity in few cases resulted from hematoma (n=1), recurrent laryngeal nerve palsy (n=1), tracheomalacia (n=1) and pulmonary complications (n=2). Conclusion: Airway management in patients with tracheal compression due to benign goiter is quite straightforward and can be managed in the conventional manner with little or no complications.
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Affiliation(s)
- Binu Sajid
- Department of Anesthesiology, Government Medical College, Kozhikode, Kerala, India
| | - K Rekha
- Department of Anesthesiology, Government Medical College, Kozhikode, Kerala, India
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Abstract
The acutely obstructed airway is a medical emergency that can potentially result in serious morbidity and mortality. Apart from the latest advancements in anaesthetic techniques, equipment and drugs, publications relevant to our topic, including the United Kingdom's 4th National Audit Project on major airway complications in 2011 and the updated American Society of Anesthesiologists' difficult airway algorithm of 2013, have recently been published. The former contained many reports of adverse events associated with the management of acute airway obstruction. By analysing the data and concepts from these two publications, this review article provides an update on management techniques for the acutely obstructed airway. We discuss the principles and factors relevant to the decision-making process in formulating a logical management plan.
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Affiliation(s)
- Patrick Wong
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Jolin Wong
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - May Un Sam Mok
- Department of Anaesthesiology, Singapore General Hospital, Singapore
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Wong P, Chieh Liew GH, Kothandan H. Anaesthesia for goitre surgery: A review. PROCEEDINGS OF SINGAPORE HEALTHCARE 2015. [DOI: 10.1177/2010105815596095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Goitres are relatively common and, in extreme cases, present unique challenges (particularly in airway management) for the anaesthetist. There are no specific guidelines from the Difficult Airway Society (United Kingdom) or the American Society of Anesthesiologists for the management of the obstructed airway. We therefore present the principles governing the provision of safe anaesthesia for goitre surgery including formulating a plan ABC for patients with a stable airway and for those presenting with acute airway obstruction.
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Affiliation(s)
- Patrick Wong
- Department of Anaesthesiology, Singapore General Hospital, Singapore
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Abstract
Airway management is one of the most important aspects of anesthesia care. Although the incidence of difficult intubation is low, predicting a potentially difficult airway can ensure that necessary staff and equipment are available. A preoperative airway evaluation should include a history and physical examination focusing on elements that can cause problems with intubation. When indicated, flexible fiberoptic laryngoscopy can add valuable information regarding the upper aerodigestive anatomy. Specific patient and situational factors should be considered. Alternative plans should be defined before the initiation of anesthesia. Management of a complex airway should be a coordinated effort between anesthesiologists and otolaryngologists.
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Affiliation(s)
- Karla O'Dell
- Department of Otolaryngology, Head and Neck Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo Street, Los Angeles, CA 90033, USA.
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