Case Report on Table Extubation of a Patient with Tracheomalacia after Thyroidectomy for large Retrosternal Goiter

Anesthetic management of patients with retrosternal goiter remains challenging as acute airway compromise may occur both during induction and recovery of anesthesia. We report the case of a 51 year old lady with retrosternal goiter and tracheal deviation who underwent total thyroidectomy. Comprehensive contingency plans were an essential prerequisite for successful management of difficult airway, including rigid bronchoscopy and emergency tracheostomy. Awake oral fiberoptic intubation was performed with wire reinforced endotracheal tube (ETT). The tumor was successfully removed via the cervical approach. There was evidence of tracheomalacia, hence after careful assessment, the trachea was extubated over a ventilating bougie . A close working relationship between anesthesiologists and surgeons was the key to the safe use of anesthesia and uneventful recovery of this patient.