Anesthetic management of giant thyroid tumor with cardiac comorbidity causing tracheal compression: a case report

This case report described the entire process of a 72-year-old Chinese woman undergoing resection of a giant thyroid tumor. The novelty of this case report lies in its emphasis on the crucial role of anesthetic management for giant thyroid tumors, particularly in patients with concurrent cardiac comorbidities.

We present a 72-year-old Chinese female with a giant thyroid tumor caused respiratory compromise due to tracheal compression, complicated by atrial septal defect. She required general anesthesia for tumor resection. A multidisciplinary team developed critical contingency strategies: (1) awake endotracheal intubation under direct laryngoscopy, (2) a remimazolam/sufentanil combination for procedural tolerance, (3) improved tracheal catheter preparation, and (4) surgical tracheostomy readiness. Anesthesia maintenance was achieved with sevoflurane, supplemented by sufentanil and remifentanil for multimodal analgesia and vecuronium/mivacurium neuromuscular blockade. Successful tumor resection achieved complete decompression, with no postoperative complications documented during 30-day follow-up.

This case demonstrates that meticulous interdisciplinary communication and structured perioperative protocols form the cornerstone of safe anesthesia practice for patients with dual pathology of airway compromise and cardiac comorbidities, providing crucial insights for managing such complex clinical scenarios.