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[Goiter and pregnancy: a cause of predictable difficult intubation]
K Rezig1, N Diar, D Benabidallah
1Service d'anesthésie-réanimation, CHI André Grégoire, 93150 Montreuil, France. kamel.rezig@chi-andre-gregoire.fr
Annales Francaises D'Anesthesie Et De Reanimation
|September 4, 2001
Summary
Pregnancy can cause thyroid changes, including enlargement. A 36-week pregnant woman with airway obstruction from a large goiter was successfully managed with awake intubation, cesarean delivery, and thyroidectomy.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Anesthesiology
Background:
- Pregnancy is associated with significant physiological changes in the thyroid gland, including alterations in function and potential enlargement.
- Airway compromise during pregnancy due to thyroid pathology is a rare but critical obstetric emergency.
- Multinodular goiters can lead to tracheal compression, posing risks to both the mother and fetus.
Observation:
- A 36-week pregnant patient presented with acute upper airway obstruction.
- The obstruction was caused by a large multinodular goiter compressing the trachea.
- Standard airway management techniques were considered high-risk due to the patient's condition.
Findings:
- Successful management was achieved using an awake, oral fiberoptic intubation.
- A combined procedure involving cesarean section and thyroidectomy was performed.
- This approach effectively resolved the airway obstruction and ensured fetal delivery.
Implications:
- This case highlights a successful strategy for managing severe airway obstruction in late-term pregnancy.
- Awake fiberoptic intubation is a valuable technique in managing high-risk airways during pregnancy.
- Combined cesarean section and thyroidectomy can be a safe and effective approach for select patients.