title: Risk factors for perioperative airway difficulty and evaluation of intubation approaches among patients with benign goiter.
abstract: OBJECTIVE
  The objective was to determine patient and gland characteristics associated with difficult intubation in patients undergoing thyroidectomy for goiter and to assess different methods of intubation in these patients.
  
  
  METHODS
  This study was an IRB-approved, retrospective chart review of 112 consecutive patients undergoing hemithyroidectomy or total thyroidectomy for thyroid goiter from 2009-2012 at an academic tertiary care facility in Bronx, New York. Patient demographics, thyroid gland characteristics (gland weight and nodule size), presence of preoperative symptoms (dyspnea, dysphagia, and hoarseness), and radiographical findings (tracheal compression, tracheal deviation, and substernal extension of the thyroid gland) were recorded. Anesthesia records were reviewed for method of intubation, as well as success or failure of intubation attempts.
  
  
  RESULTS
  Nineteen patients (17.0%) were men and 93 (83.0%) were women. The age of the patients included in the study ranged from 14 to 86 years with a mean ± SD age of 53.5 ± 14.7 years. Difficult intubation was noted with 13 (11.6%) patients. Only patient age was significantly associated with difficult intubation. The mean age of patients with airway difficulty was 60.7 ± 3.7 years compared to 52.1 ± 1.5 years in those who did not experience airway difficulty (P = .04). No other reviewed risk factors were found to be significantly associated with difficult intubation. Fiberoptic intubation (FOI) was used in 38 patients and difficult intubation occurred in 18.4% (7/38). Direct laryngoscopy with transoral intubation (LTOI) was used in 58 patients, in whom 3.4% (2/58) experienced a difficult intubation. FOI was aborted 6 times and LTOI was subsequently successful in each of these cases.
  
  
  CONCLUSIONS
  Our results suggest that benign nodular goiter disease does not pose significant challenges to intubation in our patient cohort. The technique of intubation deviated from the initial plan several times in the FOI group, whereas LTOI was ultimately successful in every case. Our data suggest that the role of fiberoptic intubation for patients with large goiters should be further refined.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Loftus
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Ow
authors.forename: Bianca
authors.initials: B
authors.lastname: Siegel
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Tassler
authors.forename: Richard V
authors.initials: RV
authors.lastname: Smith
authors.forename: Hillel W
authors.initials: HW
authors.lastname: Cohen
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Schiff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology / Q000628:therapy*; D005260:Female; D006044:Goiter, Nodular / Q000150:complications / Q000601:surgery*; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D013965:Thyroidectomy; D055815:Young Adult
keywords: airway management; airway obstruction; endotracheal intubation; goiter; intubation; nodular