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A559
October 16, 2011
8:00:00 AM - 11:00:00 AM
Room Hall B2 Area E
Anaesthesia for Retrosternal Thyroidectomy - A case series
JANE SNELL, M.B.,Ch.B., Ged Dempsey, M.B.,B.Ch.
UNIVERSITY HOSPITAL AINTREE, LIVERPOOL, United Kingdom
Introduction

Retrosternal thyroidectomy invokes fears of difficult airway management, airway obstruction and tracheomalacia. There is limited evidence suggesting that contrary to popular belief airway difficulties are uncommon1. Optimal airway management remains undecided: Cook found the prospective airway management plans of several leading airway experts to differ and even oppose each other2. This review aims to help dispel some of these concerns.

Methods

A retrospective review was conducted of retrosternal thyroidectomies performed in a UK tertiary referral centre from February 2008 to December 2010. Anaesthetic, operative, radiological and pathological data were obtained from medical notes and hospital software systems.

Results



In our case series of thirteen patients presenting for retrosternal thyroidectomy only one patient had difficulties with airway management and subsequent ventilation; emergency tracheostomy was performed and surgery abandoned (patient 6a). This case had been managed by a non-head and neck specialist. On return to theatre under the care of a head and neck anaesthetist, the airway was successfully managed with an awake fibreoptic intubation (patient 6b). All other patients were uneventfully managed using direct laryngoscopy. All glands were removed through the neck with no requirement to proceed to sternotomy. There were no incidences of post-operative respiratory problems and no patients had evidence of tracheomalacia assessed using palpation by the operating surgeon.

Conclusion

There is a growing body of evidence to suggest fears surrounding anaesthesia for retrosternal thyroidectomy maybe unfounded. Endotracheal tube advancement through compressed trachea and tracheomalacia do not appear problematic. Our case series suggests that it is possible to manage many of these people via general anaesthesia and direct laryngoscopy avoiding the requirement for awake intubation. However, given the significant potential for morbidity, we feel that all such cases should be managed in a dedicated head and neck unit.

References

1. Bennett AMD, Hashmi SM, Premachandra DJ, Wright MM. The myth of tracheomalacia and difficult intubation in cases of retrosternal goitre. J Laryngol Otol 2004; 118: 778-780.

2. Cook TM, Morgan PJ, Hersch PE. Equal and opposite expert opinion. Airway obstruction caused by a retrosternal throid mass: management and prospective international opinion. Anaesthesia 2011 Apr 12 Epub ahead of print.
Figure 1

Copyright © 2011 American Society of Anesthesiologists