Anaesthesia for retrosternal thyroidectomy

Abstract

Thyroidectomy is one of the commonest endocrine surgeries performed globally.^1,2 The introduction of general anaesthesia, infection prophylaxis and basic cautery during the mid-19th century significantly reduced the mortality from thyroid surgery, which was historically greater than 40%.³ Modern-day thyroidectomy has a mortality rate of 0.065%. Cervical haematomas, complications from prolonged intubation, tracheal injury and heart failure account for most deaths, typically in patients of advanced age, with large goitres and upper airway complications.⁴ Even in specialised endocrine surgery units, major complications such as cervical haematomas, hypoparathyroidism and recurrent laryngeal nerve (RLN) injuries still occur.⁴

Amongst the anaesthesia community, it is widely believed that endotracheal intubation is difficult and tracheomalacia is common in patients with retrosternal goitres (RSG).^5-7 This perception likely stems from anecdotal case reports, but is not supported by larger series or prospective studies.^5-10 Furthermore, there is little consensus amongst experts on the ideal approach to airway management in patients with RSG and obstructive symptoms.¹¹