Awake intubation using Pentax AWS videolaryngoscope after failed fibreoptic intubation in a morbidly obese patient with a massive thyroid tumour and tracheal compression.

摘要

A morbidly obese 53-year-old male, weighing 134 kg with a body mass index of 45.3, was scheduled for total thyroidectomy. He presented with a massive multi-nodular goitre with pressure symptoms which included difficulty breathing and hoarseness of voice. His past medical history included severe obstructive sleep apnoea on home continuous positive airway pressure therapy, ischemic heart disease, chronic obstructive airway disease, type II diabetes mellitus and hypertension. Computed tomography of his neck demonstrated a gross enlargement of the thyroid gland with the right and left lobes measuring 11x6x5 cm and 10x6x7 cm respectively. This was associated with displacement of the trachea to the right and narrowing of the airway to a minimum transverse diameter of 7.7 mm. (Figure 1) Preoperative nasal endoscopy showed that the upper airway was very narrow, roughly 2 mm at the glottis.