Airway obstruction caused by the systemic inflammatory syndrome associated with trauma and retrosternal goitre

Patil, Shashank; Bhayani, Sadiq

doi:10.1016/j.resuscitation.2009.06.018

Cited by 2 publications

(1 citation statement)

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“…Currently, the literature on perioperative anesthesia management for patients with huge retrosternal goiter is mostly limited to case reports. 10,11 For patients with massive retrosternal goiter, the anesthesiologist should first focus on whether there is a difficult airway and then select an anesthesia induction protocol and tracheal intubation method. Most researchers believe that patients with massive retrosternal goiter often have difficult airways, but recent research results do not support this view.…”

Section: Discussionmentioning

confidence: 99%

Airway Management of Retrosternal Goiters in 22 Cases in a Tertiary Referral Center

Pan

Chen

et al. 2020

TCRM

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Background The present study aimed to investigate the incidence and extent of difficult airway management in patients with massive retrosternal goiter. Design An 8-year retrospective analysis was performed to identify patients who underwent massive retrosternal thyroidectomy. A total of 22 cases were identified as giant retrosternal goiter, followed by a review of each patient’s preoperative computerized tomography imaging. Interventions There were no cases of failed intubation. Twenty patients underwent uneventful tracheal intubation using direct laryngoscopy or Glidescope. Thirteen patients received a muscle relaxant intravenously, and two patients were induced with sevoflurane. Five patients underwent awake tracheal intubation, including awake fiberoptic intubation in three patients. Before entering the operating theatre, the remaining two patients underwent oral tracheal intubation with Glidescope in the emergency department. Results Two patients had tracheal intubation before they entered the operating theatre. Once entering vocal cords, tracheal intubation can pass beyond the site of the tracheal obstruction without difficulty. One patient died because of serious perioperative bleeding owing to the adhesion between the retrosternal goiter and large vessel within the thoracic cavity. One patient experienced dyspnea after extubation and was intubated again. Conclusion Intravenous induction of muscle relaxant using laryngoscopy or Glidescope is feasible in patients with massive benign retrosternal goiter. The incidence of difficult intubation and postoperative tracheomalacia is likely too rare. Furthermore, perioperative bleeding and postoperative airway complication seem frequent.

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Section: Discussionmentioning

confidence: 99%

Airway Management of Retrosternal Goiters in 22 Cases in a Tertiary Referral Center

Pan

Chen

et al. 2020

TCRM

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Anaesthesia for massive retrosternal thyroidectomy in a tertiary referral centre

Dempsey

Snell

Coathup

et al. 2013

British Journal of Anaesthesia

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When managed within a dedicated H&N operating theatre we have found a low incidence of difficult tracheal intubation, difficult mechanical ventilation nor postoperative respiratory difficulties in patients with massive RSG and mid-tracheal compression because of benign multi-nodular goitre. Surgical complications, however, are more frequent than those associated with cervical thyroidectomy with RLN injury and postoperative bleeding more likely.

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Airway obstruction caused by the systemic inflammatory syndrome associated with trauma and retrosternal goitre

Cited by 2 publications

References 1 publication

Airway Management of Retrosternal Goiters in 22 Cases in a Tertiary Referral Center

Airway Management of Retrosternal Goiters in 22 Cases in a Tertiary Referral Center

Anaesthesia for massive retrosternal thyroidectomy in a tertiary referral centre

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