Anesthesia in a child with massive thyroid enlargement

Dere, Kamer; Teksöz, Ertan; Şen, Hüseyin; Orhan, Mehmet Emın; Özkan, Sezai; Dağlı, Güner

doi:10.1111/j.1460-9592.2008.02547.x

Cited by 6 publications

(11 citation statements)

References 5 publications

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“…The specific problems associated with them are difficulty in securing airway, adequate exposure, blood loss, and potential risk of injury to recurrent laryngeal nerve, oesophagus and the parathyroid gland due to distorted and displaced anatomy [4][5][6][7][8][9]. Moreover there is an increased possible association of tracheomalacia, tracheal compression, retrosternal extension and skin complications due to ulceration or infiltration by the massively enlarged goiter [4][5][6][7][8][9].…”

Section: Discussionmentioning

confidence: 99%

“…Each case is dealt with differently and the technical difficulties both surgical and anaesthetic must be anticipated in order to minimize perioperative morbidity and mortality, Intubation of these patients could be demanding due to gross tracheal deviation, compression or tracheomalacia and should be anticipated by the anaesthetists in the preanaesthetic assessment [4,6,[8][9][10]. Intubation is usually achieved in these difficult cases by flexible intubation using relatively smaller sized tube (size 4 and above) in case of severe narrowing [4,6,7] (Tables 1 & 2). Awake intubation using fiberoptics and local anaesthetics has been performed successfully in extremely difficult cases [4,6,8].…”

Section: Discussionmentioning

confidence: 99%

“…Intubation is usually achieved in these difficult cases by flexible intubation using relatively smaller sized tube (size 4 and above) in case of severe narrowing [4,6,7] (Tables 1 & 2). Awake intubation using fiberoptics and local anaesthetics has been performed successfully in extremely difficult cases [4,6,8]. Another difficult situation is when the stenosis is over a long segment.…”

Section: Discussionmentioning

confidence: 99%

“…The removal of the other half would then be relatively easy due to the space created. Care is taken to preserve the parathyroids and prevent injury to the recurrent laryngeal nerve [3][4][5][6][7][8][9][10]. Use of intraoperative nerve monitoring has been reported to be very useful in these difficult cases [11].…”

Section: Discussionmentioning

confidence: 99%

“…Most of these goiters are of moderate size being less than 100 grams [3]. Glands weighing more than 500 grams are extremely unusual and often result as a consequence of ignorance, neglect, lack of inadequate medical facility, fear of undergoing surgery or due to an unusually rapid growth as in malignancy [4][5][6][7]. These patients pose a specific surgical challenge and need to be managed by experienced surgeons.…”

Section: Introductionmentioning

confidence: 99%

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Thyroidectomy for Massive Goiter Weighing more than 500 Grams. Technical Difficulties, Complications and Management. Review

Machado¹

2011

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Background: Multinodular goiter is a relatively common thyroid disorder with a marked female preponderance. Most of these goiters weigh less than 100 grams with those weighing more than 500 grams being exceptional. The massively expanding goiter due to the strategic anatomic location of thyroid gland, in addition to being cosmetically disfiguring can seriously compromise the patency of the trachea and oesophagus. Thyroidectomy for such goiters is a surgical challenge due to the possible association of tracheomalacia, retrosternal extension, skin involvement and the difficulty in intubation and dissection of the thyroid gland due to distorted and displaced anatomy. Material and methods: While presenting 2 patients who underwent thyroidectomy for glands weighing more than 500 grams, the literature is reviewed to analyze the technical difficulties and approach in such patients and the frequently encountered complications in them and their management. Results: A review of the literature revealed an additional 7 cases of patients who had undergone thyroidectomy for glands weighing more than 500 grams. Massively enlarged goiter was often associated with tracheomalacia, tracheal stenosis and retrosternal extension. Difficulty during surgery was most often encountered in establishing the airway and in exposure of the gland particularly when the skin was involved. The predominant postoperative complications were related to respiratory distress as a consequence of tracheomalacia and tracheal stenosis. Conclusion: In spite of the technical challenge related to the airway, and thyroidectomy, surgery continues to be the best option in experienced hands due to its distinct advantage of its immediate effect and complete resolution of compressive symptoms.

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