Emergency partial thyroidectomy under cervical block to relieve severe acute airway obstruction from thyroid cancer

A 75 year old male, Nigerian, retired civil servant presented to the Surgical Endocrine Unit of the Olabisi University Teaching Hospital, Sagamu, Nigeria with features of severe acute airway obstruction from advanced thyroid cancer. He was immediately worked up for an emergency partial thyroidectomy within an hour of arrival in the hospital under superficial bilateral cervical blockage using 2% xylocaine with aderanalin (30 mls) 1:100,000 with mild sedation, using 10 mg pentazocine and 5 mg diazepam as other forms of anaesthesia were not feasible because of his worsening respiratory distress. Findings at operation were a very haemorrhagic, friable thyroid gland with all the lobes matted together. He had isthmusectomy with bilateral partial lobectomy to relieve pressure on the trachea. Respiration improved in the immediate post-operative period as reflected by the values of arterial blood gases. He was maintained on respiration and intranasal oxygen therapy in Intensive Care Unit (ICU) for 2 days. He had an uneventful recovery and was discharged 2 weeks after surgery. He had radiotherapy and was followed up in the clinic for a year.