Airway Management in Substernal Goiter Surgery

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Otolaryngology

Background:

• Substernal goiter surgery presents unique airway management challenges.
• Predicting difficult intubation is crucial for patient safety.

Purpose of the Study:

• To review airway management strategies for substernal goiter surgery across three hospitals.
• To identify preoperative factors predicting the need for advanced airway techniques.

Main Methods:

• Retrospective chart review of 179 patients undergoing surgery for substernal goiter (2009-2017).
• Analysis of intubation success rates, number of attempts, and associated patient/thyroid factors.
• Multivariable logistic regression to identify independent predictors of difficult intubation.

Main Results:

• 90.5% of patients were successfully intubated with direct or video laryngoscopy.
• 17.4% required more than one intubation attempt.
• Higher BMI (P=.02) and larger thyroid size (P=.009) were associated with increased intubation attempts. BMI was the sole independent predictor (OR 1.056, P=.015).

Conclusions:

• Routine intubation is feasible for most substernal goiter surgeries.
• Thyroid-specific factors like tracheal compression were not predictors of difficult intubation.
• Classic patient factors, particularly BMI, are associated with challenging airway management.