1887
Volume 2020, Issue 3
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Imminent upper airway obstruction due to life-threatening tracheal stenosis of any cause is a challenging situation. We present a challenging case of total thyroidectomy for a malignant, invasive, and highly vascularized thyroid carcinoma that has invaded the surrounding tissues, including the sternum and mediastinum, resulting in compression of the trachea with indentation. The patient presented with a significant symptomatic tracheal stenosis, the narrowest area of that was 4 mm. Airway management in such cases presents a particular challenge to the anesthesiologists, especially considering that the option of tracheostomy is very difficult most of the time due to the highly swollen thyroid and distorted anatomy. A meticulous history of the patient's illness had been taken, and a comprehensive preoperative evaluation was conducted, including construction of a 3D model airway, virtual endoscopy, and transnasal tracheoscopy. On the day of the surgery, the airway was managed through spontaneous respiration using intravenous anesthesia and the high-flow nasal oxygen (STRIVE-Hi) technique. It was then secured with intubation using a straw endotracheal tube (Tritube®) with an internal diameter (ID) of 2.4 mm and an outer diameter of 4.4 mm with the help of a fiberscope and D-MAC blade of a video laryngoscope. At the end of the procedure, the airway was checked with a fiber optic scope, which showed an improvement in the narrowed area. This enabled us to replace the Tritube with an adult cuffed ETT of size 6.5 mm ID, and the patient was transferred intubated to the surgical ICU. Two days later, the patient's tracheal diameter was evaluated with the help of a fiberoptic scope and extubated successfully in the operating theater.

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2021-01-28
2021-03-01
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References

  1. Cancer.Net. (2019). Thyroid Cancer - Statistics. [online] Available from: https://www.cancer.net/cancer-types/thyroid-cancer/statistics [Accessed 18 Oct. 2019].
  2. Yamaguchi K, Fujimoto K, Koide Y, Kurahashi K. Safe induction of anesthesia in 3 patients with severe tracheal stenosis caused by thyroid cancer. Masui. 2013; 62:17882.
    [Google Scholar]
  3. Sajid B, Rekha K. Airway management in patients with tracheal compression undergoing thyroidectomy: A retrospective analysis. Anesth. Essays Res. 2017; 11:1: 110116.
    [Google Scholar]
  4. Liou J, Chow L, Chan K, Tsou M. Successful anesthetic management of a patient with thyroid carcinoma invading the trachea with tracheal obstruction, scheduled for total thyroidectomy. J. Chin. Med. Assoc. 2014; 77:9: 496499.
    [Google Scholar]
  5. Price D, Wong R, Randolph G. Invasive thyroid cancer: Management of the trachea and esophagus. Otolaryngol. Clin. North Am. 2008; 41:6: 11551168.
    [Google Scholar]
  6. Booth A, Vidhani K, Lee P, Thomsett C. SponTaneous Respiration using IntraVEnous anaesthesia and Hi-flow nasal oxygen (STRIVE Hi) maintains oxygenation and airway patency during management of the obstructed airway: An observational study. Br. J. Anaesth. 2017; 118:3: 444451.
    [Google Scholar]
  7. Cho J, Jeong M, Choi J, Cho J, Lee H, Kim D, Kim K, Seo J. Anesthetic consideration for patients with severe tracheal obstruction caused by thyroid cancer -A report of 2 cases-. Korean J. Anesthesiol. 2010; 58:4: 396400.
    [Google Scholar]
  8. Lee P, Booth A, Vidhani K. Spontaneous respiration using intravenous anesthesia and high-flow nasal oxygen (STRIVE Hi) management of acute adult epiglottitis. A A Pract. 2018; 10:4: 7375.
    [Google Scholar]
  9. Jeong YI, Jun IG, Ha SS, Kwon HJ, Lee YM. Extracorporeal membrane oxygenation for the anesthetic management of a patient with a massive intrathoracic goiter causing severe tracheal obstruction with positional symptoms: A case report. Med. (Baltim.). 2019; 98:42: e17650. doi:10.1097/MD.0000000000017650.
    [Google Scholar]
  10. Kim SH, Song S, Kim YD et al. Outcomes of extracorporeal life support during surgery for the critical airway stenosis. ASAIO J. 2017; 63:1: 99103. doi:10.1097/MAT.0000000000000458.
    [Google Scholar]
  11. Foong TW, Ramanathan K, Chan KKM, MacLaren G. Extracorporeal membrane oxygenation during adult noncardiac surgery and perioperative emergencies: A narrative review. J. Cardiothorac. Vasc. Anesth. 2021; 35:1: 281297.
    [Google Scholar]
  12. Avenia N, Vannucci J, Monacelli M et al. Thyroid cancer invading the airway: Diagnosis and management. Int. J. Surg. 2016; 28: Suppl 1: S75S78. doi:10.1016/j.ijsu.2015.12.036.
    [Google Scholar]
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