Airway management of a huge thyroid mass: A case report

Ahmet Gültekin; İlker Yıldırım; Ayhan Sahin; Cavidan Arar

doi:10.28982/josam.732126

Authors

Ahmet Gültekin https://orcid.org/0000-0003-4570-8339
İlker Yıldırım https://orcid.org/0000-0002-4245-1163
Ayhan Sahin https://orcid.org/0000-0002-3539-2353
Cavidan Arar https://orcid.org/0000-0003-1952-427X

DOI:

https://doi.org/10.28982/josam.732126

Keywords:

Difficult airway, Fiberoptic, Huge goiter, Entubation

Abstract

In large thyroidal masses with excessive tracheal shift, the laryngeal opening is usually in the normal position and intubation may not be difficult. However, in some cases, such as retrosternal big thyroid glands, airway management can get challenging. Failure to successfully manage difficult airways is responsible for 30% of deaths attributed to anesthesia, with approximately 600 deaths annually. Successful awake intubation can be performed in 88-100% by considering the appropriate position and experience of anesthesiologist with a fiberoptic bronchoscope. However, the path to be followed should be determined according to each patient.

Downloads

Download data is not yet available.

References

Bajwa SJS, Sehgal V. Anesthesia and thyroid surgery: The never ending challenges. Indian J Endocr Metab. 2013;17:228-34.

Shaha AR. Difficult airway and intubation in thyroid surgery. Ann Otol Rhinol Laryngol. 2015;124(4):334-5. doi: 10.1177/0003489414553654.

Amathieu R, Combes X, Abdi W, Housseini LE, Rezzouq A, Dinca A, et al. An algorithm for difficult airway management, modified for modern optical devices (Airtraq Laryngoscope; LMA CTrachTM) a 2-year prospective validation in patients for elective abdominal, gynecologic, and thyroid surgery. Anesthesiology. 2011;114:25-33.

Wakeling HG, Ody A, Ball A. Large goitre causing difficult intubation and failure to intubate using the intubating laryngeal mask airway: lessons for next time. Br J Anesth. 1998;81:979–81.

Tutuncu AC, Erbabacan E, Teksoz S, Ekici B, Koksal G, Altintas F, et al. The Assessment of Risk Factors for Difficult Intubation in Thyroid Patients. World J Surg. 2018;42(6):1748-53. doi: 10.1007/s00268-017-4391-y.

Orozco-Diaz E, Alvarez-Rios JJ, Arceo-Diaz JL, Ornelas-Aguirre JM. Predictive factors of difficult airway with known assessment scales. Cir Cir. 2010;78(5):393-9.

Gómez-Ríos MA. Can fiberoptic bronchoscopy be replaced by video laryngoscopy in the management of difficult airway? Rev Esp Anestesiol Reanim. 2016;63:189-91.

Gómez -Ríos MA, Gaitini L, Matter I, Somri M. Guidelines and algorithms for managing the difficult airway. Rev Esp Anestesiol Reanim. 2018;65(1):41-8. doi: 10.1016/j.redar.2017.07.009.

Voyagis GS, Kyriakis KP. The effect of goiter on endotracheal intubation. Anesth Analg. 1997;84:611-2.

Adnet F, Barron SW, Racine SX, Clemessy JL, Fournier JL, Plaisance P, et al. The intubation difficulty scale (IDS): proposal and evaluation of a new score characterizing the complexity of endotracheal intubation. Anesthesiology. 1997;87:1290-7.

Paix AD, Williamson JA, Runciman WB. Crisis management during anaesthesia: difficult intubation. Qual Saf Health Care. 2005;14:e5.

Nimmagadda U, Salem MR, Crystal GJ. Preoxygenation: physiologic basis. Benefits, and potential risks. Anesth Analg. 2017;124:507-17.

Reasoner DK, Warner DS, Todd MM, Hunt SW, Kirchner J. Acomparison of anesthetic techniques for awake intubation in neurosurgical patients. J Neurosurg Anesthesiol. 1995;7:94-9.

Zaouter C, Calderon J, Hemmerling TM. Videolaryngoscopy as a new standard of care. Br J Anaesth. 2015;114:181-3.

Popat M, Mitchell V, Dravid R, Patel A, Swampillai C, Higgs A. Difficult Airway Society guidelines for the management of tracheal extubation. Anaesthesia. 2012;67:318-40.