Anaesthetic Techniques for Thyroidectomy in Patients with Giant Goitre
AbstractAim: To determine safe anaesthesia management techniques for giant goiters at thyroidectomy.
Patients and methods: Over a ten year period January 1988 - December 1997, the different anaesthetic techniques used at the University of Nigeria Teaching Hospital Enugu for management of very large goiters at thyroidectomy were studied. Goiters spanning the whole of anterior and lateral triangles of the neck, with minimum dimension 30cm by 30cm (termed ‘giant' in our unit) were identified on presentation and enrolled for the study. The age and sex of the patients, size of the goiters, their duration, associated symptoms and signs and the reason for presentation to the hospital were documented.
The patients were investigated and prepared for thyroidectomy. The airway control techniques employed for thyroidectomy in these patients were also noted.
Results: Twelve patients were studied. They all presented with varying degrees of dyspnoea, dysphagia, pressure and pain in the neck and frequent cough and chest pain. Preoperative tracheostomy was carried out on two patients. Four patients were intubated awake following inhalation of nebulized lidocaine. Inhalational induction and intubation after spraying the cords with lidocaine was carried out on six patients. These techniques were respectively related to pre-operative stridor at rest, positional stridor and the uncompromised airway.
Conclusion: Safe anaesthetic techniques for thyroidectomy in giant goiters are dictated by preoperative airway status. Postoperative complications are related to the extent and finesse of surgery.
Key words: Giant goiter, Anaesthesia, Thyroidectomy.
Journal of College of Medicine Vol.10(1) 2005: 6-9