RT Book, Section
A1 Zhang, Jinbin
A1 Chung, Frances
A1 Hung, Orlando R.
A2 Hung, Orlando R.
A2 Murphy, Michael F.
SR Print(0)
ID 1146618750
T1 Management of a Patient with OSA for Total Thyroidectomy
T2 Hung's Difficult and Failed Airway Management, 3e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9781259640544
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1146618750
RD 2024/04/19
AB A  55-year-old  female  with  a  BMI  of  42  kg·m−2,  presented  for  total  thyroidectomy  for  a  long-standing  multinodular  goiter.  She  appeared  clinically  euthyroid  and  her  thyroid  function  tests  were  normal.  Although  mild  retrosternal  extension,  high  tracheal  deviation  and  compression  were  demonstrated  on  the  CT  scan,  the  patient  did  not  exhibit  any  compressive  symptoms.  On  preoperative  screening  using  the  STOP-Bang  Questionnaire,  the  patient  was  deemed  to  be  at  high  risk  for  OSA  in  view  of  the  presence  of  loud  snoring,  daytime  sleepiness,  history  of  hypertension,  BMI  more  than  35  kg·m−2,  and  age  above  50  years  old.  She  offered  the  information  that  she  was  told  “it  was  difficult  to  insert  a  breathing  tube”  during  her  previous  surgery  10  years  ago,  but  could  not  recall  further  details.  Airway  examination  demonstrated  good  mouth  opening,  a  short  neck  but  good  cervical  range  of  movement,  Mallampati  Class  IV  and  thyromental  distance  of  6  cm.  Referral  to  sleep  physician  for  sleep  study  evaluation  was  offered  but  the  patient  declined  due  to  financial  reasons.  She  also  adamantly  refused  awake  intubation  despite  a  thorough  explanation  of  the  indications.  After  discussion  with  the  surgeon  and  patient,  the  plan  was  to  proceed  with  the  surgery  with  risk  mitigating  strategies  in  view  of  patient's  refusal  for  further  investigations.