Anesthetic challenges in a large multinodular thyroidectomy at a peripheral hospital

Abstract

We present a case of large multinodular goiter with retrosternal extension scheduled for thyroidectomy under general anesthesia (GA). We anticipated difficult airway due to tracheal compression as well as perioperative hemodynamic instability. She had had hyperthyroidism previously, which had been treated successfully. We planned and prepared to encounter airway problems in the light of Difficult Airway Society guidelines. After counselling and consent, her upper airways were sprayed with local anesthetic solution. Awake, flexible fiberoptic nasal intubation was performed and GA was induced. She had two episodes of bradycardia and hypotension peri-operatively, which were treated with inj atropine. Tracheostomy was performed in anticipation of tracheomalacia, which was de-cannulated on 3rd postoperative day. She was discharged on 4th post-operative day.Citation: Ikram M, Mahboob S. Anesthetic challenges in a large multinodular thyroidectomy at a peripheral hospital. Anaesth pain & intensive care 2019;23(3):311- 313

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway

“…224–227,300–303 Case reports also observed successful intubation with flexible intubation scopes (Category B4-B evidence ). 304–356…”