Respiratory complications after thyroidectomy and the need for tracheostomy in patients with a large goitre

Rahim, A A Abdel; Ahmed, Mohamed E.; Hassan, Mohamed A.

doi:10.1046/j.1365-2168.1999.00978.x

Cited by 70 publications

(59 citation statements)

References 4 publications

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“…4 Preoperatively, difficult intubation has been associated with tracheal deviation 5 and thyroid cancer. 6 If there is any concern regarding the potential for respiratory or ventilatory compromise, preoperative work-up should include chest x-ray and CT-scan of the neck and chest.…”

Section: Discussionmentioning

confidence: 99%

“…9,12 These etiologies may have been contributing factors during the postoperative course. Tracheomalacia, though a common cause of postoperative airway obstruction, 4 was ruled out by direct palpation of the trachea following surgery. Although the recurrent laryngeal nerves appeared to be intact, the patient demonstrated weak left vocal cord movement postoperatively.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Upper airway compromise secondary to edema in Graves’ disease

Shan¹,

Hatzakorzian²,

Sherman³

et al. 2006

Can J Anesth/J Can Anesth

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Upper airway compromise secondary to edema in Graves’ disease

Shan¹,

Hatzakorzian²,

Sherman³

et al. 2006

Can J Anesth/J Can Anesth

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“…1 In another report from Sudan, 6 (5.8%) of 103 patients undergoing thyroid surgery for a large goiter had tracheomalacia, with 5 (4.8%) requiring a tracheostomy. 2 These and several other studies indicate a link between a longstanding goiter and tracheomalacia. 7,9-11 Conversely, Lacoste et al followed a cohort of 3,008 patients undergoing thyroidectomy and found that none of the cases developed tracheal collapse after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Airway obstruction after thyroidectomy is a rare but serious complication 2,3,7 which may lead to catastrophic consequences. The causes of airway obstruction specifically related to thyroid resection include postoperative wound hematoma, vocal cord palsy secondary to recurrent Fig.…”

Section: Discussionmentioning

confidence: 99%

Management of a patient with tracheomalacia and supraglottic obstruction after thyroid surgery

Lee

Cooper

Goldstein

2011

Can J Anesth/J Can Anesth

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Purpose We describe an unusual combination of dynamic supraglottic, glottic, subglottic, and intrathoracic airway obstructions following a total thyroidectomy. These problems were anticipated, documented videographically, and managed preemptively. Clinical features Following a total thyroidectomy, we replaced the endotracheal tube with a laryngeal mask airway, namely, the LMA-Classic TM , in a patient with symptomatic tracheal compression and probable obstructive sleep apnea. Spontaneous ventilation was observed bronchoscopically through the LMA-Classic. Supraglottic swelling, extraglottic collapse on inspiration, and intrathoracic collapse on expiration were documented prior to recovery. These observations were of sufficient concern to warrant reinsertion of the endotracheal tube and subsequent tracheal extubation over a tube exchanger. Thereafter, we provided face-mask continuous positive airway pressure using a Boussignac mask with an endotracheal ventilation catheter in situ. Conclusions Acute airway collapse following thyroid surgery is a rare and potentially serious complication. Diagnosis by conventional methods may be insensitive. Difficulties may not be apparent until the patient becomes distressed after tracheal extubation, and this circumstance will worsen airway compromise. In such a state, reestablishing the airway can become life-threatening. We describe the preemptive identification, physiologic manifestations, and management of the supraglottic and subglottic obstruction exemplified by this case. RésuméObjectif Nous de´crivons une combinaison inhabituelle d'obstructions dynamiques supraglottique, glottique, sous-glottique et intrathoracique des voies ae´riennes apre`s une thyroı¨dectomie totale. Ces proble`mes ont e´te´anticipe´s, documente´s par vide´o et pris en charge de façon pre´ventive. É léments cliniques A`la suite d'une thyroı¨dectomie totale, nous avons remplace´la sonde endotrache´ale par un masque larynge´, le LMA-Classic TM , chez un patient pre´sentant une compression trache´ale symptomatique et une apne´e obstructive du sommeil probable. La ventilation spontane´e a e´te´observe´e par bronchoscopie via le LMA-Classic. Un oede`me supraglottique, un collapsus extraglottique al 'inspiration et un collapsus intrathoracique a`l'expiration ont e´te´documente´s avant le re´veil. Ces observations e´taient suffisamment pre´occupantes pour justifier la re´insertion de la sonde endotrache´ale suivie de l'extubation trache´ale sur un e´changeur de sonde. Par la suite, nous avons mis en place une ventilation a`pression positive continue avec un masque facial de Boussignac et un cathe´ter endotrache´al de ventilation in situ.Electronic supplementary material The online version of this article (doi:10.1007/s12630-011-9570-y) contains supplementary material, which is available to authorized users.

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“…[5] Difficulty with intubation may be caused by an enlarged thyroid gland producing tracheal deviation, compression, or both. [6] Amathieu et al [4] concluded that classical predictive criteria like mouth opening <35 mm, Mallampati III or IV, limited neck movements <80°, and thyromental distance were reliable predictors of difficult airway.…”

Section: Discussion:-mentioning

confidence: 99%

Anaesthetic Management of a Case of Large Benign Thyroid Mass With Diabetes Mallitus – An Anticipated Difficult Airway Patient.

rajnish¹,

Parikh²,

Upadhayaya³

2017

IJAR

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Respiratory complications after thyroidectomy and the need for tracheostomy in patients with a large goitre

Abstract: Multiple preoperative risk factors in a patient with a large goitre may be useful in predicting the need for planned tracheostomy following thyroidectomy.

Cited by 70 publications

References 4 publications

Upper airway compromise secondary to edema in Graves’ disease

Upper airway compromise secondary to edema in Graves’ disease

Management of a patient with tracheomalacia and supraglottic obstruction after thyroid surgery

Anaesthetic Management of a Case of Large Benign Thyroid Mass With Diabetes Mallitus – An Anticipated Difficult Airway Patient.

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