Tracheostomy with thyroidectomy: indications, management and outcome: a prospective study.
OBJECTIVE
This study aims to determine the indications, course and outcome of pre-operative and post-thyroidectomy tracheostomy.


METHODS
This is a prospective descriptive study conducted in Khartoum Teaching Hospital in the period between March 2000 and March 2005. Fifty-nine patients had tracheostomy out of 964 thyroidectomy patients, giving an incidence of 6%.


RESULTS
The decision of doing tracheostomy was taken intra-operatively in 41 patients (69%), all presenting with strider. In 25 of those 41 patients there was intra-operative tracheal deformity with narrowing (>50% of tracheal circumference on radiology) and gland adherence to the tracheal wall; the remaining 16 patients had tracheomalacia. Of those 41 patients, 25 presented with severe strider and needed urgent surgery (5 with recurrent anaplastic carcinoma, 5 with intrathoracic goitres that necessitated median sternotomy and 15 with huge goitres (of whom 7 were recurrent goitres). In the remaining 18 patients (31%) emergency post-operative tracheostomy was done following endotracheal extubation up to 48 h post-operatively. There were 2 deaths (3.4%); one patient died due to tracheostomy care and the other from myocardial infarction.


CONCLUSIONS
Tracheostomy is a safe procedure and gives a good alternative to delayed endotracheal extubation in post-thyroidectomy patients expected to have respiratory failure in places where post-operative anaesthetic care is lacking.
ElBashier
ElHadi Mohamed
EM
Khartoum Teaching Hospital, Khartoum, Sudan. rasheid@usa.net
Hassan Widtalla
Abu Bakr
AB
ElMakki Ahmed
Mohamed
M
D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000601:surgery; D003371:Cough / Q000209:etiology; D005260:Female; D006042:Goiter / Q000601:surgery; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011446:Prospective Studies; D012135:Respiratory Sounds; D013530:Surgical Wound Infection / Q000209:etiology; D013964:Thyroid Neoplasms / Q000601:surgery; D013965:Thyroidectomy; D014133:Tracheal Diseases / Q000601:surgery; D014139:Tracheostomy / Q000009:adverse effects; D014832:Voice Disorders / Q000209:etiology