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Intra-Op Nerve Monitoring for Large Retrosternal Goitre - Anaesthetist's Dilemma.

Soumi Pathak¹, Mamta Dubey², Vishal Yadav³

¹Consultant Anaesthesiology, Rajiv Gandhi Cancer Institute & Research Centre (RGCIRC), Sector 5, Delhi, India.

Indian Journal of Otolaryngology and Head and Neck Surgery : Official Publication of the Association of Otolaryngologists of India

|May 27, 2025

Summary

This report details anesthetic management and nerve monitoring for severe tracheal compression due to retrosternal goiter. Thyroid cartilage electrodes offer an effective alternative for intraoperative nerve monitoring when standard endotracheal tubes are unsuitable.

Keywords:

Airway management Awake fibreoptic intubation Retrosternal goitre

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Area of Science:

Anesthesiology
Neurosurgery
Otolaryngology

Background:

Retrosternal goiters can cause severe tracheal compression, posing anesthetic challenges.
Standard endotracheal tubes for intraoperative nerve monitoring (IONM) are ineffective with distal tracheal compression.
Pemberton's sign indicates significant thoracic inlet obstruction.

Purpose of the Study:

To describe the anesthetic management and IONM in a patient with a retrosternal goiter causing severe tracheal compression.
To present an alternative method for IONM when standard endotracheal tubes are not feasible.

Main Methods:

Successful anesthetic management of a patient with >70% tracheal occlusion.
Intermittent intraoperative nerve monitoring (IONM) using thyroid cartilage electrodes.
Monitoring of V1-R1-R2-V2 signals.

Main Results:

Effective anesthetic management was achieved.
Thyroid cartilage electrodes provided reliable IONM despite severe distal tracheal compression.
The alternative IONM approach successfully monitored nerve function.

Conclusions:

Anesthetic management for severe tracheal compression is feasible.
Thyroid cartilage electrodes are a viable alternative for IONM in cases of distal tracheal compression.
This technique ensures effective neuromonitoring when standard methods fail.