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Periodicum biologorum, Vol. 127 No. 1-2, 2025.

Original scientific paper

https://doi.org/10.18054/pb.v127i1-2.35764

Airway management in retrosternal goiter surgery, retrospective study

Ivana Bureš Valentić orcid id orcid.org/0000-0001-9205-3801 ; Zagreb University Hospital Centre, Department of Anesthesiology and ICU, Zagreb, Croatia *
Matea Mrčelić orcid id orcid.org/0009-0008-3216-3409 ; Zagreb University Hospital Centre, Department of Anesthesiology and ICU, Zagreb, Croatia
Renata Curić Radivojević orcid id orcid.org/0000-0002-5984-617X ; Zagreb University Hospital Centre, Department of Anesthesiology and ICU, Zagreb, Croatia; University of Zagreb, School of Medicine, Zagreb, Croatia
Krešimir Gršić ; University of Zagreb, School of Medicine, Zagreb, Croatia; Zagreb University Hospital Centre, Department of Otolaryngology, Head and Neck Surgery, Zagreb, Croatia; Libertas International University, Zagreb, Croatia
Drago Prgomet ; University of Zagreb, School of Medicine, Zagreb, Croatia; Zagreb University Hospital Centre, Department of Otolaryngology, Head and Neck Surgery, Zagreb, Croatia

* Corresponding author.

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Abstract

Background and purpose: Retrosternal goiter refers to thyroid enlargement in which the lower pole of the thyroid is not palpable with the neck in a hyperextended position. The presence of a mass in the anterior mediastinum and displacement of the trachea are the risk factors for a difficult airway. The aim of this study was to present our experience with airway management in patients with retrosternal goiter.
Materials and methods: We conducted a retrospective observational study of patients undergoing elective retrosternal goiter surgery in a tertiary center over one year. We analyzed the preoperative evaluation data and the planning, techniques and outcome of airway management.
Results: From January 1st to December 31st, 2024, a total of 349 patients underwent thyroid surgery at our center. Among 72 patients admitted for goiter surgery, 26 patients were diagnosed with retrosternal goiter. A preoperative computerized tomography scan was performed in most patients and revealed 11 patients with massive retrosternal goiter. Intravenous induction to anesthesia with direct or video laryngoscopy was the preferred method of intubation. No significant complications were recorded.
Conclusion: If there are no additional risk factors, intravenous induction of anesthesia and intubation with direct or video laryngoscopy are acceptable methods of airway management in patients with retrosternal goiter. Flexible nasendoscopy and virtual bronchoscopy are valuable methods for airway assessment and may reduce the need for awake fiberoptic intubation in complex cases. However, multicentric studies with larger sample sizes are needed to confirm our findings.

Keywords

airway management; intubation, intratracheal; anesthesia; goiter, substernal; thyroidectomy

Hrčak ID:

340272

URI

https://hrcak.srce.hr/340272

Publication date:

1.12.2025.

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