Massive Thyromegaly,Difficult Airway, Full stomach

[jafo1964]

We occassionally encounter difficult airway patients for emergency surgery that cannot be accessed by central neuraxial blockade or is deemed not fully safe.
Some of these patients may have distorted anatomical landmarks in the neck due to thyromegaly or other masses thus precluding the performance of percutaneous airway blocks
Also the issue of performing airway blocks in a potential full stomcah patient is an issue.
any ideas on how to approach such a complex case coming for emergency surgery

[frontier]

hi,
in my view if laryngoscopy is not difficult& mallampati grading is ok,then rapid sequence intubation with succinylcholine with cricoid pressure will suffice.with regards

[marquezxg]

Assuming that patient has history of difficult airway management and/or goiter compression symptoms the case is indeed very challenging.
Although the sux approach seems straight forward, the airway can collapse and things could get a bit scary. My approach will be AP/lateral xrays of the neck, reassurance of the patient, titrated sedation (remi or dex might help), appropriate topicalization of nose and throat, awake FO intubation as per ASA algorithm. If not available, not enough expertise, go with other awake methods, including old reliable blind nasal awake. Place NG drainage catheter and suction then take it out. All sorts of gastric protection with ranetidine or omeprazol etc plus non particulate antacids.
Regards