Retrosternal Goitre-An Anaesthetic Challenge

Abstract

Airway management of patients undergoing thyroidectomy for Retrosternal Goitre (RSG) poses a unique challenge. Associated comorbidities, manipulation of the airway by the surgeons, airway compromise during induction, intubation, intraoperative and postoperative period can contribute to adverse events. We describe anaesthetic management of a patient with long standing goitre for 61 years with retrosternal extension with tracheal narrowing and compression for thyroidectomy. We secured the airway in an awake, spontaneously breathing patient under topical anaesthesia and sedation using direct laryngoscopy. Airway management of RSG is challenging at every phase of anaesthesia. Maintaining airway patency, vigilance and preparedness are keys to the success of intubation.

Keywords

• awake intubation
• difficult intubation
• tracheal narrowing
• tracheomalacia