Goiter-related predictors of difficult intubation: Case report

Abstract

Introduction: Preoperative examination and recognizing the risk factors for a difficult airway gives us the time for optimal preparation for difficult airway management. For goiter patients, in addition to the standard risk factors, there are goiter-related factors that may address to suspect of difficult intubation. Case report: Through this case report we summarize the presentation, airway examination and management of a patient with huge goiter. About 25-years earlier he noticed a swelling on the neck which increased in size progressively. Over the years he developed compressive symptoms, such as dysphagia, hoarseness and change in voice quality. All classical risk factors for difficult intubation, as well as goiter-related factors, were preoperatively evaluated. The neck circumference, the left displacement of the larynx and the radiological findings all pointed to a possible difficulty in airway management. The plan was to perform a direct laryngoscopy using a video-laryngoscope, without using a muscle relaxant, whereas the alternate plan was to use a flexible fibreoptic bronchoscope. The patient's airway was anesthetized with lignocaine spray into the laryngo-pharynx 30 minutes and 10 minutes before intubation. Oxygen was administered via facemask. The nasal catheter was placed to provide apnoic oxygenation during laryngoscopy and intubation. After induction of anesthesia a smooth video laryngoscopy was performed without using a muscle relaxant. A reinforced endotracheal tube with an intubating stylet was inserted without any difficulties in passing and placing the tube. Conclusion: Careful planning and detailed preoperative preparation are of crucial importance for a safe intraoperative and postoperative outcome in thyroid patients.

Keywords

• goiter
• difficult intubation
• airway management
• video-laryngoscopy