Successful Intubation With Muscle Relaxants In A Patient With Airway Stenosis Caused By Massive Retrosternal Goiter: A Case Report

The severe airway stenosis compressed by massive retrosternal goiter is rare in clinic. This paper reported a case of successful endotracheal intubation anesthesia in a patient with airway stenosis and discussed the principles of anesthesia management. A 35-year old, 51 kg weighed lady was prepared for massive retrosternal thyroidectomy. Magnetic resonance imaging (MRI) and computed tomography (CT) of anterior cervical region showed a massive elliptical substernal goiter, which was 25.1 x 18.7 x 15.4 cm in size. Tumor embolization and electric bronchoscopy were implemented before surgery. The main airway was narrow throughout with a minimum diameter of 4.7 x 20.1 mm due to extrinsic forces of goiter, while the narrowest airway was located in subglottic with a minimum diameter of 4.0 x 7.2 mm due to thickened tracheal mucosal and extrinsic forces of goiter. A wire endotracheal tube of 7.0 was inserted successfully under the guidance of electric bronchoscope after muscle relaxants were administered. The patient developed stridor and dynamic airway collapse after extubation, so tracheotomy was implemented. Anesthesia for complex airway stenosis required accurate preoperative evaluation. Different types of stenosis required different methods of intubation. Muscle relaxants can be used in intubation for patients with airway stenosis.