Authors Keywords: anaesthesia, retrosternal thyroid, thyroidectomy Abstract

Thyroidectomy is one of the commonest endocrine surgeries performed globally.1,2 The introduction of general anaesthesia, infection prophylaxis and basic cautery during the mid-19th century significantly reduced the mortality from thyroid surgery, which was historically greater than 40%.3 Modern-day thyroidectomy has a mortality rate of 0.065%. Cervical haematomas, complications from prolonged intubation, tracheal injury and heart failure account for most deaths, typically in patients of advanced age, with large goitres and upper airway complications.4 Even in specialised endocrine surgery units, major complications such as cervical haematomas, hypoparathyroidism and recurrent laryngeal nerve (RLN) injuries still occur.4

Amongst the anaesthesia community, it is widely believed that endotracheal intubation is difficult and tracheomalacia is common in patients with retrosternal goitres (RSG).5-7 This perception likely stems from anecdotal case reports, but is not supported by larger series or prospective studies.5-10 Furthermore, there is little consensus amongst experts on the ideal approach to airway management in patients with RSG and obstructive symptoms.11

Author Biography T Kleyenstuber, University of the Witwatersrand

Department of Anaesthesia, School of Clinical Medicine, Faculty of Health Sciences, Rahima Moosa Mother & Child Hospital, University of the Witwatersrand, South Africa

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