title: Successful anesthetic management of a patient with thyroid carcinoma invading the trachea with tracheal obstruction, scheduled for total thyroidectomy.
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.
authors.affiliation: Department of Anesthesiology, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Jing-Yang
authors.initials: JY
authors.lastname: Liou
authors.affiliation: Department of Anesthesiology, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Lok-Hi
authors.initials: LH
authors.lastname: Chow
authors.affiliation: Department of Anesthesiology, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Kwok-Hon
authors.initials: KH
authors.lastname: Chan
authors.affiliation: Department of Anesthesiology, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC. Electronic address: mytsou8095@gmail.com.
authors.forename: Mei-Yung
authors.initials: MY
authors.lastname: Tsou
mesh_terms: D000368:Aged; D000402:Airway Obstruction / Q000209:etiology*; D000758:Anesthesia / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation; D008297:Male; D013964:Thyroid Neoplasms / Q000150:complications / Q000601:surgery*; D013965:Thyroidectomy; D014132:Trachea; D014135:Tracheal Stenosis / Q000209:etiology*
keywords: extracorporeal membrane oxygenation; fiberoptic bronchoscopy; tracheal tumor