Perioperative Management Of Huge Goiter With Compromized Airway

摘要

Goiter is a known risk factor for difficult airway management. We report the anesthetic management of a case of huge multinodular goiter with compromised airway. When thyroid enlargement is accompanied by airway deformity, it presents an aggravating factor for difficult direct laryngoscopy and difficult tracheal intubation. Under similar situations where the trachea is compressed and markedly shifted to one side, and whenever possible, airway access under local anesthesia constitutes better alternative to failed fiberoptic intubation. Case Report A 46-year-old male patient who was not known to have any medical illness, presented with history of diffuse neck swelling noted 6 yr ago. The swelling was increasing gradually in size and was associated with dyspnea especially with neck flexion. There was no history of dysphagia, pain, change of voice or any history suggestive of hyper or hypothyroidism. The patient was fully investigated in another hospital and the diagnosis of huge multinodular goiter was established for which he was taken to the operating theater for thyroidectomy. The procedure was aborted due to unsuccessful tracheal intubation. The patient was referred to our hospital for further management. On examination, he looked well, not in distress or sweating. His body weight 107 kg, heart rate 80 beats/min and blood pressure 130/80 mmHg. Neck examination showed a huge swelling about 10x11 cm, moving with swallowing, firm in consistency, nodular surface, not tender with normal overlying skin (Fig 1). Plain neck x-ray showed huge mass involving the pretracheal and prevertebral areas (Fig 2). Percussion note was dull over the upper sternum with no systolic bruit over the lump. Trachea was displaced to the right side. No neck veins engorgement or cervical lymphadenopathy.