Successful anesthetic management of a patient with thyroid carcinoma invading the trachea with tracheal obstruction, scheduled for total thyroidectomy

• Published in: Journal of the Chinese Medical Association 2014-09, Vol.77 (9), p.496-499
• Main Authors: Liou, Jing-Yang, Chow, Lok-Hi, Chan, Kwok-Hon, Tsou, Mei-Yung
• Format: Article
• Language: English
• Subjects: Aged; Airway Obstruction - etiology; Anesthesia - methods; Extracorporeal Membrane Oxygenation; fiberoptic bronchoscopy; Humans; Internal Medicine; Intubation, Intratracheal - instrumentation; Male; Thyroid Neoplasms - complications; Thyroid Neoplasms - surgery; Thyroidectomy; Trachea; Tracheal Stenosis - etiology; tracheal tumor
• ISSN: 1726-4901; 1728-7731
• DOI: 10.1016/j.jcma.2014.06.006

Abstract We report a case of large thyroid carcinoma with tracheal and esophageal invasion who presented with preoperative stridor scheduled for total thyroidectomy and segmental tracheal resection. Careful and comprehensive preoperative anesthetic planning was done. Extracorporeal circulation membrane oxygenation (ECMO) was set up and running prior to induction under local anesthesia, due to an increased international normalized ratio (INR) and fear of bleeding in the airway. Fiberoptic bronchoscopy (FOB) is the first choice in many circumstances of difficult airway. However, we twice failed to intubate under FOB guidance. Successful intubation was done with traditional laryngoscopy and a Glidescope. The operative course was smooth. The oral endotracheal tube (ETT) was changed to a nasal ETT after surgery with the Glidescope. FOB-assisted intubation carries a chance of failure, and in critical patients, the presence of other intubating modalities such as video-assisted or fiberoptic-assisted technology or safety measures, including ECMO, will greatly increase the safety of anesthesia and surgery.