BACKGROUND: The thyroid gland is an important endocrine gland of the body placed anteriorly in the neck just in front of 3 rd , 4 th & 5 th tracheal cartilage. Enlargement of this gland causes narrowing and deviation of trachea leading to difficulty in breathing. Hence the anaesthetic management of this patient can be challenging. CASE: A 68 years old lady with cervical multinodular goiter who had left hemithyroidectomy done 20 years ago has now come with complain of a swelling in front of the right side of neck with shift of trachea to left. In order to avoid airway compromise with the induction of anaesthesia fibreoptic bronchoscope (FOB) was used to secure the airway. A wake intubation with 6mm endotracheal tube via nasal root was done. Patient was kept intubated in view of tracheomalacia and shifted to ICU. Extubated after 24 hours after demonstrating leak test using fiberoptic bronchoscope for direct visualization of trachea. CONCLUSION: FOB is considered a gold standard in this situation. Extubation in ICU is essential to rescue the airway if tracheal collapse occurred.
Hyperparathyroid crisis is a serious and potentially life threatening complication of markedly increased serum calcium concentrations most commonly due to severe primary hyperparathyroidism. Identification and resection of the adenoma leads to cure of the disease. Parathyroidectomy for localized adenomas can be done under local anaesthesia and sedation or a cervical plexus block with sedation besides general anaesthesia. We report a case of successful management of a patient who presented with hyperparathyroid crisis and underwent emergency parathyroidectomy under combined deep and superficial cervical plexus block.
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