Difficult airway after late postoperative bleeding in a case of total thyroidectomy, tracheal resection and reconstruction

Abstract

Background: Airway management is a challenge in surgery involving the trachea. Methods: A lady with carcinoma thyroid infiltrating into trachea was taken up for total thyroidectomy and tracheal resection/reconstruction surgery. Airway was secured with fiber-optic bronchoscope guided tracheal intubation preventing trauma to the infiltrated lesion. Surgical and anesthetic management were unremarkable. Seven days after surgery, patient had massive hemoptysis and was taken up for an emergent re-exploration. Securing the airway was difficult due to edema and lungs were soiled by the bleed. There was a rent in right common carotid artery, which was unusual, as no surgical dissection was done in its vicinity. Results: Fortunately, the outcome was successful despite a major complication along with a compromise of the airway. Conclusions: The management of a difficult airway complication needs adequate planning, cooperation and support of all teams.