Pan Yuanming, Chen Chaoqin, Yu Lingya, Zhu Shengmei, Zheng Yueying
Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, People's Republic of China.
Department of Radiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, People's Republic of China.
Ther Clin Risk Manag. 2020 Dec 22;16:1267-1273. doi: 10.2147/TCRM.S281709. eCollection 2020.
The present study aimed to investigate the incidence and extent of difficult airway management in patients with massive retrosternal goiter.
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.
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.
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.
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.
本研究旨在调查巨大胸骨后甲状腺肿患者困难气道管理的发生率及程度。
进行了一项为期8年的回顾性分析，以确定接受巨大胸骨后甲状腺切除术的患者。共识别出22例巨大胸骨后甲状腺肿患者，随后对每位患者的术前计算机断层扫描成像进行回顾。
无插管失败病例。20例患者使用直接喉镜或Glidescope顺利进行气管插管。13例患者静脉注射肌肉松弛剂，2例患者使用七氟醚诱导麻醉。5例患者接受清醒气管插管，其中3例为清醒纤维支气管镜插管。其余2例患者在进入手术室前，于急诊科使用Glidescope进行了口腔气管插管。
2例患者在进入手术室前已进行气管插管。一旦进入声门，气管插管可顺利通过气管梗阻部位。1例患者因胸骨后甲状腺肿与胸腔内大血管粘连导致围手术期严重出血死亡。1例患者拔管后出现呼吸困难，再次进行了插管。
对于巨大良性胸骨后甲状腺肿患者，使用喉镜或Glidescope进行静脉诱导肌肉松弛剂插管是可行的。困难插管和术后气管软化的发生率可能极低。此外，围手术期出血和术后气道并发症似乎较为常见。
