Airway challenges in thyroid surgery

Abstract

Huge goiters can lead to tracheal compression and, hence, difficulty in endotracheal intubation. This along with retro-sternal extension makes it an anticipated difficult airway scenario. In this report, we present a case of huge goiter (papillary carcinoma) compromising the airway, which presented with difficult airway for total thyroidectomy. CT scan of neck revealed retro-sternal extension with the pretracheal plane fixed to the trachea. Trachea was completely pushed to the right. We successfully performed an awake direct laryngoscopy and successful intubation by locally anesthetizing the airway. Plan B was ready with fiberoptic bronchoscopy and rigid bronchoscopy. Patient was successfully extubated in the intensive care unit (ICU).