Goitre and difficulty of tracheal intubation.

Area of Science:

• Anesthesiology
• Otolaryngology
• Thoracic Surgery

Background:

• Goitres can present challenges during airway management.
• Assessing intubation difficulty in patients with goitre is crucial for patient safety.

Purpose of the Study:

• To evaluate laryngoscopy and tracheal intubation difficulty in patients with large goitres.
• To identify predictors of difficult intubation in this specific patient group.

Main Methods:

• Prospective observational study comparing 80 patients with large goitres to 77 controls.
• Utilized the Intubation Difficulty Scale (IDS) to quantify intubation difficulty.
• Defined large goitre by specific physical and radiological criteria.

Main Results:

• Patients with goitres showed higher Cormack grades during initial laryngoscopy (p<0.05) and higher IDS scores (p=0.001), indicating slightly increased difficulty.
• However, moderate to major intubation difficulty (IDS>5) and intubation time were similar between groups.
• Severe tracheal stenosis (> or =30%) and reduced mouth opening (<4.4cm) were significant predictors of increased intubation difficulty.

Conclusions:

• Large goitres generally lead to only minor increases in intubation difficulty.
• Clinicians should anticipate greater challenges when severe tracheal stenosis and reduced mouth opening coexist in patients with goitre.