Thyroid Surgery and a Missed Difficult Airway

Mukherji, Shailendra; Pai, Poonam; Velankar, P M; Bhargava, A K; Sharma, Rohit

doi:10.1016/s0377-1237(17)30946-2

Cited by 1 publication

(3 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In routine general anesthesia, "can't intubate, can't ventilate" (CICV) or "can't intubate, can't oxygenate" (CICO) situation is encountered in less than 1 in 5,000, out of which emergency surgical airway is required only by 1 in 50,000; yet it accounts for up to 25% of all anesthesia-related deaths. 5 Specific causes identified for difficult airway in thyroidectomy include cancerous goiters, tracheal compression, retrosternal extension and a large gland, 2,3,6 out of which the presence of a cancerous goiter is a major predictor for difficult endotracheal intubation. 3 Apart from these factors, vocal cord palsy also can lead to narrowing of the glottis which was the cause in this patient.…”

Section: Discussionmentioning

confidence: 99%

“…5 Specific causes identified for difficult airway in thyroidectomy include cancerous goiters, tracheal compression, retrosternal extension and a large gland, 2,3,6 out of which the presence of a cancerous goiter is a major predictor for difficult endotracheal intubation. 3 Apart from these factors, vocal cord palsy also can lead to narrowing of the glottis which was the cause in this patient. It was secondary to permanent vocal cord injury during previous thyroidectomy and infiltration of both vocal cords by tumour recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…1 These surgeries usually do not pose significant challenges during airway management. 2,3 Although, there can be instances where the anesthesiologist will encounter a difficult airway. Therefore, meticulous preoperative airway assessment is of utmost importance.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A ‘can’t intubate, can’t oxygenate’ situation during an elective redo thyroid surgery; successful rescue and the lessons learnt

Jayaweera¹,

Abayadeera²,

DASSANAYAKE³

2022

Anaesth. pain intensive care

View full text Add to dashboard Cite

Pre-operative assessment of a patient for routine redo thyroidectomy requires a detailed airway assessment, clear documentation and formulation of an appropriate airway management plan by the anesthetist. Failure to identify problems related to oxygenation and ventilation during surgery will cause grave consequences to the patient and an unpleasant experience to the anesthetist and the surgeon. Redo thyroid surgery can be challenging. There is a possibility of preoperative vocal cord palsy due to previous surgical insult and infiltration by tumour recurrence, that can lead to difficulty in ventilation following induction of anesthesia. Therefore, it is mandatory to perform a detailed assessment of the airway using conventional as well as the advanced techniques. We report the lessons learnt from a 42-year-old, ASA I, male patient scheduled for a redo thyroidectomy who could not be intubated nor ventilated, following a “missed difficult airway,” despite a clean history and the available past records. An emergency airway was declared and managed according to Difficult Airway Society (DAS) guidelines which finally resulted in a successful outcome. Subsequent evaluation by the ENT team revealed an absent glottic opening due to bilateral vocal cord palsy which resulted in a “can’t intubate, can’t oxygenate” state in this patient. Citation: Jayaweer DA, Abayadeera A, Dassanayake V. ‘Can’t intubate, can’t oxygenate’ during an elective redo thyroid surgery; A successful rescue and the lesson learnt. Anaesth. pain intensive care 2022;26(5):727-729. DOI: 10.35975/apic.v26i5.1984

show abstract