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Haidar Ahmad H, Ibrahim R, Fadel A. Neck Sinus Post-Thyroidectomy Secondary to Retained Oxidized Regenerated Cellulose: A Case Report. Cureus 2023; 15:e37605. [PMID: 37197101 PMCID: PMC10184474 DOI: 10.7759/cureus.37605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 05/19/2023] Open
Abstract
The present study aims to report the first case of chronic neck sinus post-thyroidectomy caused by oxidized regenerated cellulose (ORC). A 55-year-old female patient underwent a total thyroidectomy operation. Three months after the surgery, the patient presented with persistent purulent discharge and sinus at the site of the drain. A CT scan of the neck showed a fistula tract, deep-neck fluid collection, and bilateral paratracheal high-density lesions at the thyroid bed, suggesting infected foreign bodies. The patient underwent surgery, during which the mesh of the ORC was found nonresorbed at the paratracheal space. The treatment involved neck exploration with the removal of all retained material and excision of the sinus tract. The patient had a favorable outcome following the surgical excision of the sinus tract and the removal of retained hemostatic materials. Further research is needed to explore the risk factors and preventive measures for neck sinus formation to enhance the safety and outcomes of thyroidectomy.
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Affiliation(s)
| | - Rana Ibrahim
- Research Department, Saint George Hospital, Beirut, LBN
| | - Abbas Fadel
- Infectious Diseases Department, Saint George Hospital, Beirut, LBN
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2
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Kriege M, Hilt JA, Dette F, Wittenmeier E, Meuser R, Staubitz JI, Musholt TJ. Impact of direct laryngoscopy vs. videolaryngoscopy on signal quality of recurrent laryngeal nerve monitoring in thyroid surgery: a randomised parallel group trial. Anaesthesia 2023; 78:55-63. [PMID: 36166515 DOI: 10.1111/anae.15865] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 12/24/2022]
Abstract
In thyroid surgery, intra-operative neuromonitoring signals of the recurrent laryngeal nerve can be detected by surface electrodes on a tracheal tube positioned at the vocal fold level. The incidence of difficult tracheal intubation in patients undergoing thyroidectomy for nodular goitre ranges from 5.3% to 20.5%. The aim of this study was to compare videolaryngoscopy with conventional direct laryngoscopy as methods for proper placement of the surface electrode to prevent insufficient intra-operative nerve signal quality. In this prospective randomised trial, adult patients requiring tracheal intubation during thyroid surgery were randomly allocated to two groups of C-MAC® (Macintosh style blade) videolaryngoscope or direct laryngoscopy using the Macintosh laryngoscope. Primary outcome was the incidence of insufficient signal electromyogram amplitude level (< 500 μV) after successful tracheal intubation. A total of 260 (130 per group) participants were analysed. An insufficient signal was more frequent with direct laryngoscopy (35/130, 27%), compared with C-MAC (12/130, 9%, p < 0.001). First-pass tracheal intubation success rate was lower with direct laryngoscopy (86/130 (66%)) compared with the C-MAC (125/130 (96%)) (p < 0.0001). Cormack and Lehane grade ≥ 3 was observed more frequently with direct laryngoscopy (16/130 (12%)), compared with the C-MAC (0/130, (0%)) (p < 0.0001). The results suggest that videolaryngoscopy has an impact on the quality of the initial intra-operative neuromonitoring signal in patients undergoing thyroid surgery, and this technique can provide optimised surface electrode positioning.
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Affiliation(s)
- M Kriege
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - J A Hilt
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - F Dette
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - E Wittenmeier
- Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - R Meuser
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - J I Staubitz
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - T J Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
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3
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Tasche KK, Dorneden AM, Swift WM, Boyd NH, Shonka DC, Pagedar NA. Airway Management in Substernal Goiter Surgery. Ann Otol Rhinol Laryngol 2021:34894211014794. [PMID: 34032125 DOI: 10.1177/00034894211014794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE(S) To review the experience of 3 hospitals with airway management during surgery for substernal goiter and identify preoperative factors that predict the need for advanced airway management techniques. METHODS A retrospective chart review between 2009 and 2017 of patients with substernal goiter treated surgically at 1 of 3 hospitals was performed. RESULTS Of the 179 patients included in the study, 114 (63.7%) were female, the mean age was 55.1 years (range 20-87). Direct laryngoscopy or videolaryngoscopy was successful in 162 patients (90.5%), with fiberoptic intubation used for the remaining 17 patients. Thirty-one patients (17.4%) required >1 intubation attempt; these patients had larger thyroids (201.3 g, 95% CI 155.3-247.2 g) than those intubated with 1 attempt (144.7 g, 95% CI 127.4-161.9 g, P = .009). Those who required >1 attempt had higher BMI (38.3, 95% CI 34.0-42.6 vs. 32.9, 95% CI 31.5-34.3, P = .02). Mallampati score was found to be a predictor of >1 attempt, though tracheal compression and tracheal shift were not found to be predictors of >1 attempt, nor was the lowest thyroid extent. BMI was the only independent factor on multivariable logistic regression of needing >1 attempt (odds ratio 1.056, 95% CI 1.011-1.103, P = .015). CONCLUSIONS The majority of patients undergoing surgery for substernal goiter can be intubated routinely without the need for fiberoptic intubation. Thyroid-specific factors such as lowest thyroid extent and mass effect of the gland on the trachea do not appear to be associated with difficult intubation, whereas classic patient factors associated with difficulty intubation are. LEVEL OF EVIDENCE VI.
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Affiliation(s)
- Kendall K Tasche
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Ashley M Dorneden
- Division of Otolaryngology, Department of Surgery, University of New Mexico Health Sciences, Albuquerque, NM, USA
| | - William M Swift
- Department of Otolaryngology-Head & Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Nathan H Boyd
- Division of Otolaryngology, Department of Surgery, University of New Mexico Health Sciences, Albuquerque, NM, USA
| | - David C Shonka
- Department of Otolaryngology-Head & Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Nitin A Pagedar
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
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4
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Osinaike BB, Ogunsiji AO, Joseph OC. Challenging Airway Management in a Patient with Retrosternal Goiter Presenting in Respiratory Distress. Niger J Surg 2021; 27:66-70. [PMID: 34012246 PMCID: PMC8112356 DOI: 10.4103/njs.njs_58_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/24/2020] [Accepted: 03/26/2020] [Indexed: 12/03/2022] Open
Abstract
A number of options exist for patients with anticipated difficult intubation on account of a retrosternal goiter compressing on the trachea. The chosen technique(s) to secure the airway in this delicate situation often depends on the location and degree of airway obstruction, available resources/facilities, and an anesthetist's experience and preferences. We report the case of a 68-year-old woman with severe airway obstruction from a retrosternal goiter coming for total thyroidectomy. Airway management started with an awake fiber-optic intubation, proceeded to a tracheostomy and finally to use of a rigid bronchoscope following failure of the earlier techniques to achieve adequate ventilation.
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Affiliation(s)
- Babatunde B Osinaike
- Department of Anaesthesia, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Alaba O Ogunsiji
- Department of Anaesthesia, University College Hospital, Ibadan, Nigeria
| | - Olufunke C Joseph
- Department of Anaesthesia, University College Hospital, Ibadan, Nigeria
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5
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Pan Y, Chen C, Yu L, Zhu S, Zheng Y. Airway Management of Retrosternal Goiters in 22 Cases in a Tertiary Referral Center. Ther Clin Risk Manag 2020; 16:1267-1273. [PMID: 33376336 PMCID: PMC7764631 DOI: 10.2147/tcrm.s281709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022] Open
Abstract
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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Affiliation(s)
- Yuanming Pan
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, People's Republic of China
| | - Chaoqin Chen
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, People's Republic of China
| | - Lingya Yu
- Department of Radiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, People's Republic of China
| | - Shengmei Zhu
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, People's Republic of China
| | - Yueying Zheng
- Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, People's Republic of China
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Essig GF, Niermeyer WL, Essandoh M, Dewhirst E, Gerlach RM, Gonzalez LS, Chaney MA. Averting Risk of Airway Loss During Surgical Management of Retrosternal Goiters. J Cardiothorac Vasc Anesth 2020; 34:2260-2268. [DOI: 10.1053/j.jvca.2020.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 12/17/2022]
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7
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Lee S, Youn S, Chung W, Shin Y, Lim C. Extracorporeal membrane oxygenation for surgery to remove a huge goiter causing tracheal obstruction. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.05019-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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8
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De Cassai A, Boscolo A, Rose K, Carron M, Navalesi P. Predictive parameters of difficult intubation in thyroid surgery: a meta-analysis. Minerva Anestesiol 2020; 86:317-326. [DOI: 10.23736/s0375-9393.19.14127-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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9
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Perincek G, Avci S, Celtikci P. Retrosternal Goiter: A couple of classification methods with computed tomograpy findings. Pak J Med Sci 2018; 34:1494-1497. [PMID: 30559810 PMCID: PMC6290211 DOI: 10.12669/pjms.346.15932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: The retrosternal goiter (RSG), which can be defined by different classification and its incidence between 2% and 26% of all thyroidectomized patients, is a thyroid gland disease. Our aim was to classify RSG cases with a couple of different ways, which we have detected in computed tomography (CT) imaging of the thorax. Methods: In this retrospective study conducted at Kars Harakani State Hospital Pulmonary Medicine Polyclinic between June 2014 and June 2017 in which 176 patients were included. The age, sex, diagnostic codes, retrosternal extension of the thyroid gland (aortic upper arch, aortic reaching arch and aortic inferior arch), extension type (prevascular, paratracheal retrovascular and retrotracheal), extension amount (mm) (<50% and 50%<) of thyroid gland of the patients were assessed. Results: About 56.25% (n=99) were female and the mean age was 65.9±11.4 years. The most common co-morbid disease in patients with RSG was Chronic Obstructive Pulmonary Disease (COPD) (52.3%). Thirty nine (22.2%) of the patients had associated nodule, 16 (9.1%) had accompanying tracheal pressure and one patient had nodule and tracheal pressure. 27.3% of the patients’ gland’s right lobe and 28.9% of the patients’ left lobe were extended >50% below the thoracic entry. Left thyroid gland’s (90.3%) retrosternal extension and aortic arch spread (91.2%) were more. When classified according to the trachea, the left lobe’s paratracheal and retrovascular extension (50.9%) was more. Extension amounts were similar for both thyroid lobes. Conclusion: In patients who have retrosternal goiter, goiter spread can be defined with multiple classification with thorax CT.
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Affiliation(s)
- Gokhan Perincek
- Dr. Gokhan Perincek, Department of Pulmonology, Kars Harakani State Hospital, Kars, Turkey
| | - Sema Avci
- Dr. Sema Avci, Department of Emergency Medicine, Sabuncuoglu Serefeddin Research and Training Hospital, Amasya, Turkey
| | - Pinar Celtikci
- Dr. Pinar Celtikci, Department of Radiology, Kars Harakani State Hospital, Kars, Turkey
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10
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Surgical management of intrathoracic goitres. Eur Arch Otorhinolaryngol 2018; 276:305-314. [PMID: 30506185 DOI: 10.1007/s00405-018-5213-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 11/16/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Intrathoracic goitres (ITG) often present with compressive symptoms and require specialised care by experienced surgical teams. Most ITG can be accessed by a transcervical approach (TCA) and only between 1 and 15% will require an extracervical approach (ECA). Many controversies exist regarding the clinical presentation, evaluation, selection of cases for ECA, surgical technique and outcomes. This paper reviews the recent literature on the management, outcomes and evidence-based treatment strategies of ITG. METHODS We conducted a review of the literature on the evaluation, management and outcomes of surgery for ITGs. RESULTS The incidence of cancer in the ITGs ranges between 4 and 20%. Multiplanar CT scanning offers the best preoperative evaluation and aids to determine the approach. Most ITG can be accessed by TCA and ECA are only needed in maximum 15% of cases. In experienced hands, the outcome of these surgeries is comparable to thyroid surgery for non-ITG. CONCLUSIONS Surgery for ITG is challenging. The experienced surgeon however, with few exceptions can address ITG via TCA, with outcomes comparable to those of uncomplicated thyroid surgery.
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11
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Lee PKG, Booth AWG, Lloyd BS. When Cardiopulmonary Bypass Is Not An Option—A Case of Massive Retrosternal Goiter With Severe Tracheal Compression in an Extremely Obese Patient. J Cardiothorac Vasc Anesth 2018; 32:956-959. [DOI: 10.1053/j.jvca.2017.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Indexed: 12/17/2022]
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12
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Thomas CM, Mattingly JK, Hendrickse A, Song JI. Case Report of a Massive Retropharyngeal Goiter Resulting in Laryngeal Compression. ACTA ACUST UNITED AC 2017; 9:178-181. [PMID: 28542048 DOI: 10.1213/xaa.0000000000000560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This is a rare presentation of a morbidly obese male with a massive retropharyngeal goiter causing laryngeal compressive symptoms and unique airway management challenges. Flexible laryngoscopy revealed a retropharyngeal mass circumferentially compressing the oropharynx and supraglottis and preventing the visualization of the glottis. Awake tracheostomy was performed before total thyroidectomy. Airway compression from a goiter typically results from substernal extension, which usually does not cause difficulty with endotracheal intubation. Extensive retropharyngeal extension can cause supraglottic obstruction of the airway. In these cases, optimal management consists of a closely coordinated approach between anesthesia and surgery teams to establish a surgical airway.
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Affiliation(s)
- Carissa M Thomas
- From the Departments of *Otolaryngology-Head and Neck Surgery and †Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado
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13
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Sajid B, Rekha K. Airway Management in Patients with Tracheal Compression Undergoing Thyroidectomy: A Retrospective Analysis. Anesth Essays Res 2017; 11:110-116. [PMID: 28298767 PMCID: PMC5341636 DOI: 10.4103/0259-1162.186608] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Airway management in large and retrosternal goiters with tracheal compression is often fraught with challenges and is a source of apprehension among anesthesiologists globally. Aims: In this study we attempt to delineate the preferred techniques of airway management of such cases in our institution and also to assess whether airway management was unnecessarily complicated. Setting and Design: Retrospective analysis. Materials and Methods: A retrospective review was conducted of thyroidectomies performed in our institution over a three year period from January 2013. Clinical, radiological, pathological, anesthetic and surgical data were obtained from hospital case records. Statistical Analysis: Qualitative data is represented as frequencies and percentages and quantitative data as mean and standard deviation. Results: Of 1861 thyroidectomies tracheal compression were present in 50 patients with minimum tracheal diameter ranging from 4-12mm (mean 7.84); with majority(95%) having a benign pathology. Critical tracheal compression (≤5 mm) was observed in four patients. Conventional intravenous induction and intubation under muscle relaxant was performed in majority (64%) of these patients. The rest of the cases (n=18) were intubated while preserving spontaneous ventilation after induction. Primary technique of airway management was reported successful in all cases with no instances of difficult ventilation or intubation. Postoperative morbidity in few cases resulted from hematoma (n=1), recurrent laryngeal nerve palsy (n=1), tracheomalacia (n=1) and pulmonary complications (n=2). Conclusion: Airway management in patients with tracheal compression due to benign goiter is quite straightforward and can be managed in the conventional manner with little or no complications.
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Affiliation(s)
- Binu Sajid
- Department of Anesthesiology, Government Medical College, Kozhikode, Kerala, India
| | - K Rekha
- Department of Anesthesiology, Government Medical College, Kozhikode, Kerala, India
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14
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Kaur H, Kataria AP, Muthuramalingapandian M, Kaur H. Airway Considerations in Case of a Large Multinodular Goiter. Anesth Essays Res 2017; 11:1097-1100. [PMID: 29284884 PMCID: PMC5735459 DOI: 10.4103/aer.aer_86_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Patients with large goiters pose a great challenge to the anesthesiologist regarding securing the airway without compromising the safety of the patient. The technique of intubation depends on the choice and expertise of anesthesiologist. Awake fiberoptic intubation (AFOI) is the preferred technique. We present the case of large multinodular goiter with difficult airway in which AFOI was successfully used to secure the airway. Proper assessment, planning, and preparation for airway management should be done preoperatively to ensure patient safety.
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Affiliation(s)
- Harpreet Kaur
- Department of Anaesthesiology and Critical care, Government Medical College, Amritsar, Punjab, India
| | - Amar Parkash Kataria
- Department of Anaesthesiology and Critical care, Government Medical College, Amritsar, Punjab, India
| | | | - Harjinder Kaur
- Department of Anaesthesiology and Critical care, Government Medical College, Amritsar, Punjab, India
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15
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Abstract
The acutely obstructed airway is a medical emergency that can potentially result in serious morbidity and mortality. Apart from the latest advancements in anaesthetic techniques, equipment and drugs, publications relevant to our topic, including the United Kingdom's 4th National Audit Project on major airway complications in 2011 and the updated American Society of Anesthesiologists' difficult airway algorithm of 2013, have recently been published. The former contained many reports of adverse events associated with the management of acute airway obstruction. By analysing the data and concepts from these two publications, this review article provides an update on management techniques for the acutely obstructed airway. We discuss the principles and factors relevant to the decision-making process in formulating a logical management plan.
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Affiliation(s)
- Patrick Wong
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Jolin Wong
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - May Un Sam Mok
- Department of Anaesthesiology, Singapore General Hospital, Singapore
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16
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Wong P, Chieh Liew GH, Kothandan H. Anaesthesia for goitre surgery: A review. PROCEEDINGS OF SINGAPORE HEALTHCARE 2015. [DOI: 10.1177/2010105815596095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Goitres are relatively common and, in extreme cases, present unique challenges (particularly in airway management) for the anaesthetist. There are no specific guidelines from the Difficult Airway Society (United Kingdom) or the American Society of Anesthesiologists for the management of the obstructed airway. We therefore present the principles governing the provision of safe anaesthesia for goitre surgery including formulating a plan ABC for patients with a stable airway and for those presenting with acute airway obstruction.
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Affiliation(s)
- Patrick Wong
- Department of Anaesthesiology, Singapore General Hospital, Singapore
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17
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Al-Shammari L, Jemmett K, Wikner M, Usman N. Management of a parturient with a retrosternal goitre and tracheal compression. Int J Obstet Anesth 2015; 24:201-2. [PMID: 25797241 DOI: 10.1016/j.ijoa.2015.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 02/09/2015] [Indexed: 10/24/2022]
Affiliation(s)
- L Al-Shammari
- Department of Anaesthetics, Royal London Hospital, London, UK
| | - K Jemmett
- Department of Anaesthetics, Royal London Hospital, London, UK
| | - M Wikner
- Department of Anaesthetics, Royal London Hospital, London, UK
| | - N Usman
- Department of Anaesthetics, Royal London Hospital, London, UK
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18
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Gilfillan N, Ball CM, Myles PS, Serpell J, Johnson WR, Paul E. A Cohort and Database Study of Airway Management in Patients Undergoing Thyroidectomy for Retrosternal Goitre. Anaesth Intensive Care 2014; 42:700-8. [DOI: 10.1177/0310057x1404200604] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients undergoing thyroid surgery with retrosternal goitre may raise concerns for the anaesthetist, especially airway management. We reviewed a multicentre prospective thyroid surgery database and extracted data for those patients with retrosternal goitre. Additionally, we reviewed the anaesthetic charts of patients with retrosternal goitre at our institution to identify the anaesthetic induction technique and airway management. Of 4572 patients in the database, 919 (20%) had a retrosternal goitre. Two cases of early postoperative tracheomalacia were reported, one in the retrosternal group. Despite some very large goitres, no patient required tracheostomy or cardiopulmonary bypass and there were no perioperative deaths. In the subset of 133 patients managed at our institution over six years, there were no major adverse anaesthetic outcomes and no patient had a failed airway or tracheomalacia. In the latter cohort, of 32 (24%) patients identified as having a potentially difficult airway, 17 underwent awake fibreoptic tracheal intubation, but two of these were abandoned and converted to intravenous induction and general anaesthesia. Eleven had inhalational induction; two of these were also abandoned and converted to intravenous induction and general anaesthesia. Of those suspected as having a difficult airway, 28 (87.5%) subsequently had direct laryngoscopy where the laryngeal inlet was clearly visible. We found no good evidence that thyroid surgery patients with retrosternal goitre, with or without symptoms and signs of tracheal compression, present the experienced anaesthetist with an airway that cannot be managed using conventional techniques. This does not preclude the need for multidisciplinary discussion and planning.
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Affiliation(s)
- N. Gilfillan
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria
| | - C. M. Ball
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria
| | - P. S. Myles
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria
| | - J. Serpell
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria
- Breast and Endocrine Surgery Unit, Alfred Hospital and Monash University, Melbourne, Victoria
| | - W. R. Johnson
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria
- Department of Surgery, Alfred Hospital and Monash University, Melbourne, Victoria
| | - E. Paul
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine and Monash University, Melbourne, Victoria
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19
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Landerholm K, Järhult J. Should asymptomatic retrosternal goitre be left untreated? A prospective single-centre study. Scand J Surg 2014; 104:92-5. [PMID: 24759378 DOI: 10.1177/1457496914523411] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 01/10/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Retrosternal goiter may cause symptoms of airway obstruction and dysphagia, but often it is asymptomatic and is increasingly detected incidentally with imaging investigations. Consensus has been reached that sternotomy is not necessary in most cases, as a collar incision normally suffices. Yet, surgery for retrosternal goiter is associated with more complications than cervical goiter. There is controversy over whether patients with asymptomatic retrosternal goiter should be operated. Proponents argue that retrosternal goiter may be a risk for thyroid cancer and may progress to later cause symptoms, although clear evidence is missing. PATIENTS AND METHODS Between 1984 and 2012, 132 patients underwent surgery for benign retrosternal goiter. Preoperatively, the benign nature was clinically apparent and confirmed by fine needle cytology in most cases. RESULTS Sternotomy was required in only 4 of the 132 operations. Three patients died in the postoperative period. The risk of morbidity and mortality was 16.7% in 60 patients with compression symptoms and 13.9% in 72 patients without compression symptoms (P = 0.808). Histology revealed no case of unsuspected cancer. CONCLUSION Surgery for retrosternal goiters involves a higher risk for complications than do cervical goiters, and the risk does not differ between patients with and without symptoms. This, and the fact that no patient in this study had unsuspected cancer, calls into question the rationale for surgery in patients with asymptomatic retrosternal goiter without suspected cancer.
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Affiliation(s)
- K Landerholm
- Department of Surgery, Ryhov County Hospital, Jönköping, Sweden
| | - J Järhult
- Department of Surgery, Ryhov County Hospital, Jönköping, Sweden Department of Surgery, Highland Hospital, Eksjö, Sweden
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Dempsey G, Snell J, Coathup R, Jones T. Anaesthesia for retrosternal thyroidectomy. Br J Anaesth 2014; 112:756. [PMID: 24645147 DOI: 10.1093/bja/aeu063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mackie TW, Skinner A. Anaesthesia for massive retrosternal thyroidectomy in a tertiary referral centre. Br J Anaesth 2014; 112:756. [PMID: 24645146 DOI: 10.1093/bja/aeu062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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