Anaes Cases · Airway management & difficult airway
The anticipated difficult airway — a multinodular goitre with tracheal deviation
The anticipated-difficult long case — the decision to secure the airway awake by fibreoptic intubation rather than inducing first, the preoperative work-up (flow-volume loop, CT), and the conduct of awake intubation.
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Presentation
A 55-year-old man is referred for anaesthetic assessment before thyroidectomy for a large, long-standing multinodular goitre. On examination the thyroid mass is prominent and asymmetric, and clinically it extends retrosternally. He reports orthopnoea — he becomes stridulous and dyspnoeic when lying flat — and he sleeps with three pillows. He has smoked 20 pack-years and is otherwise well, with no comorbidities. Examination of the neck shows a firm, fixed mass with restricted tracheal movement on swallowing; there is no stridor at rest in the upright position.[16]
The surgeon has requested general anaesthesia for a total thyroidectomy.[15]
References3ShowHide
- [15]Desai N, Ratnayake G, Onwochei DN, El-Boghdadly K, Ahmad I. Airway devices for awake tracheal intubation in adults: a systematic review and network meta-analysis. British Journal of Anaesthesia, 2021.PMID 34303493
- [7]Cook TM, Woodall N, Frerk C; Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project (NAP4). British Journal of Anaesthesia, 2011.PMID 21447488
- [16]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.