[Unanticipated difficult extubation].

Area of Science:

• Anesthesiology
• Otolaryngology
• Endocrinology

Background:

• Airway complications during extubation are a recognized anesthetic risk.
• While often minor, severe airway events necessitate careful management.
• This case highlights a rare cause of post-extubation respiratory distress.

Observation:

• A 59-year-old woman experienced recurrent respiratory distress and reintubation immediately after extubation.
• Initial assessments were unremarkable, but imaging revealed a large, compressive plunging goiter.
• The patient had a history of obesity and no prior intubation difficulties.

Findings:

• A large plunging goiter caused tracheal compression, leading to respiratory distress upon extubation.
• Surgical thyroidectomy successfully removed the compressive goiter.
• Post-thyroidectomy, the patient was extubated without further complications.

Implications:

• Plunging goiters should be considered in the differential diagnosis of unexplained post-extubation respiratory distress.
• Advanced imaging like CT scans is vital for identifying compressive neck masses.
• Surgical management of the underlying cause is essential for successful extubation outcomes in such cases.