Prediction of Difficult Tracheal Intubation in Thyroid Surgery

The incidence of difficult endotracheal intubation (DEI) for patients undergoing thyroidectomy has rarely been studied, and evaluation of factors linked to DEI is limited to a few studies. We undertook this prospective study to investigate the incidence of DEI in the presence of goiter (an enlargement of the thyroid gland) and to evaluate factors linked to DEI. We studied 320 consecutive patients scheduled for thyroidectomy. DEI was evaluated by an intubation difficulty scale. The trachea was intubated by an unassisted anesthesiologist, and the intubation difficulty scale was calculated. A univariate analysis was performed to identify potential factors predicting DEI, followed by a multivariate analysis. DEI was reported in 17 patients. The rate of easy tracheal intubation was 36.9%; the rate for patients who had minor difficulty of intubation was 57.8%. Sex (male), body mass index, Mallampati class, thyromental distance, neck mobility, Cormack grade, cancerous goiter, and tracheal deviation or compression were identified in the univariate analysis as potential DEI risk factors. With multivariate analysis, two criteria were recognized as independent for DEI (Cormack Grade III or IV and cancerous goiter). We conclude that the large goiter is not associated with a more frequent DEI. However, the presence of a cancerous goiter is a major factor for predicting DEI.

[1]  R. Greatorex,et al.  Respiratory complication after thyroidectomy and the need for tracheostomy in patients with a large goitre. , 1999, The British journal of surgery.

[2]  Mushtaque Ahmed,et al.  Respiratory complications after thyroidectomy and the need for tracheostomy in patients with a large goitre , 1999, The British journal of surgery.

[3]  F Adnet,et al.  The Intubation Difficulty Scale (IDS): Proposal and Evaluation of a New Score Characterizing the Complexity of Endotracheal Intubation , 1997, Anesthesiology.

[4]  G. Voyagis,et al.  The Effect of Goiter on Endotracheal Intubation , 1997, Anesthesia and analgesia.

[5]  J. Bourgain,et al.  [Difficult intubation. French Society of Anesthesia and Intensive Care. A collective expertise]. , 1996, Annales francaises d'anesthesie et de reanimation.

[6]  O. Kemmotsu,et al.  Continuous Cervical Epidural Blockade Combined with Light General Anesthesia Diminishes the Sensitivity to Isoproterenol , 1994 .

[7]  C. Berry,et al.  What Is the Best Way to Determine Oropharyngeal Classification and Mandihular Space Length to Predict Difficult Laryngoscopy? , 1994, Anesthesiology.

[8]  Hiromitsu Kobayashi,et al.  Predicting Difficult Tracheal Intubation I , 1994 .

[9]  C. McHenry,et al.  Thyroidectomy in patients with marked thyroid enlargement: airway management, morbidity, and outcome. , 1994, The American surgeon.

[10]  J. Fusciardi,et al.  Airway Complications in Thyroid Surgery , 1993, The Annals of otology, rhinology, and laryngology.

[11]  D. Spiegelhalter,et al.  Predicting difficult intubation. , 1988, British journal of anaesthesia.

[12]  Jonathan L. Benumof,et al.  Management of the Difficult Adult Airway With Special Emphasis on Awake Tracheal Intubation , 1991, Anesthesiology.

[13]  J. Benumof.  Additional safety measures when changing endotracheal tubes. , 1991, Anesthesiology.

[14]  K L Posner,et al.  Adverse respiratory events in anesthesia: a closed claims analysis. , 1990, Anesthesiology.

[15]  A. Shaha,et al.  Goiters and airway problems. , 1989, American journal of surgery.

[16]  J. R. Young,et al.  Difficult tracheal intubation: a retrospective study , 1987, Anaesthesia.

[17]  L. Gugino,et al.  A clinical sign to predict difficult tracheal intubation: a prospective study. , 1986, Canadian Anaesthetists' Society journal.