Risk factors for perioperative airway difficulty and evaluation of intubation approaches among patients with benign goiter

Patricia A. Loftus, Thomas J. Ow, Bianca Siegel, Andrew B. Tassler, Richard V. Smith, Hillel W. Cohen, Bradley A. Schiff

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective: The objective was to determine patient and gland characteristics associated with difficult intubation in patients undergoing thyroidectomy for goiter and to assess different methods of intubation in these patients. Methods: This study was an IRB-approved, retrospective chart review of 112 consecutive patients undergoing hemithyroidectomy or total thyroidectomy for thyroid goiter from 2009-2012 at an academic tertiary care facility in Bronx, New York. Patient demographics, thyroid gland characteristics (gland weight and nodule size), presence of preoperative symptoms (dyspnea, dysphagia, and hoarseness), and radiographical findings (tracheal compression, tracheal deviation, and substernal extension of the thyroid gland) were recorded. Anesthesia records were reviewed for method of intubation, as well as success or failure of intubation attempts. Results: Nineteen patients (17.0%) were men and 93 (83.0%) were women. The age of the patients included in the study ranged from 14 to 86 years with a mean ± SD age of 53.5 ± 14.7 years. Difficult intubation was noted with 13 (11.6%) patients. Only patient age was significantly associated with difficult intubation. The mean age of patients with airway difficulty was 60.7 ± 3.7 years compared to 52.1 ± 1.5 years in those who did not experience airway difficulty (P = .04). No other reviewed risk factors were found to be significantly associated with difficult intubation. Fiberoptic intubation (FOI) was used in 38 patients and difficult intubation occurred in 18.4% (7/38). Direct laryngoscopy with transoral intubation (LTOI) was used in 58 patients, in whom 3.4% (2/58) experienced a difficult intubation. FOI was aborted 6 times and LTOI was subsequently successful in each of these cases. Conclusions: Our results suggest that benign nodular goiter disease does not pose significant challenges to intubation in our patient cohort. The technique of intubation deviated from the initial plan several times in the FOI group, whereas LTOI was ultimately successful in every case. Our data suggest that the role of fiberoptic intubation for patients with large goiters should be further refined.

Original languageEnglish (US)
Pages (from-to)279-285
Number of pages7
JournalAnnals of Otology, Rhinology and Laryngology
Volume123
Issue number4
DOIs
StatePublished - 2014

Fingerprint

Goiter
Intubation
Laryngoscopy
Thyroid Gland
Thyroidectomy
Nodular Goiter
Hoarseness
Research Ethics Committees
Tertiary Healthcare
Deglutition Disorders

Keywords

  • Airway management
  • Airway obstruction
  • Endotracheal intubation
  • Goiter
  • Intubation
  • Nodular

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Risk factors for perioperative airway difficulty and evaluation of intubation approaches among patients with benign goiter. / Loftus, Patricia A.; Ow, Thomas J.; Siegel, Bianca; Tassler, Andrew B.; Smith, Richard V.; Cohen, Hillel W.; Schiff, Bradley A.

In: Annals of Otology, Rhinology and Laryngology, Vol. 123, No. 4, 2014, p. 279-285.

Research output: Contribution to journalArticle

@article{f934f5374c274aba9d3557a8be4bc245,
title = "Risk factors for perioperative airway difficulty and evaluation of intubation approaches among patients with benign goiter",
abstract = "Objective: The objective was to determine patient and gland characteristics associated with difficult intubation in patients undergoing thyroidectomy for goiter and to assess different methods of intubation in these patients. Methods: This study was an IRB-approved, retrospective chart review of 112 consecutive patients undergoing hemithyroidectomy or total thyroidectomy for thyroid goiter from 2009-2012 at an academic tertiary care facility in Bronx, New York. Patient demographics, thyroid gland characteristics (gland weight and nodule size), presence of preoperative symptoms (dyspnea, dysphagia, and hoarseness), and radiographical findings (tracheal compression, tracheal deviation, and substernal extension of the thyroid gland) were recorded. Anesthesia records were reviewed for method of intubation, as well as success or failure of intubation attempts. Results: Nineteen patients (17.0{\%}) were men and 93 (83.0{\%}) were women. The age of the patients included in the study ranged from 14 to 86 years with a mean ± SD age of 53.5 ± 14.7 years. Difficult intubation was noted with 13 (11.6{\%}) patients. Only patient age was significantly associated with difficult intubation. The mean age of patients with airway difficulty was 60.7 ± 3.7 years compared to 52.1 ± 1.5 years in those who did not experience airway difficulty (P = .04). No other reviewed risk factors were found to be significantly associated with difficult intubation. Fiberoptic intubation (FOI) was used in 38 patients and difficult intubation occurred in 18.4{\%} (7/38). Direct laryngoscopy with transoral intubation (LTOI) was used in 58 patients, in whom 3.4{\%} (2/58) experienced a difficult intubation. FOI was aborted 6 times and LTOI was subsequently successful in each of these cases. Conclusions: Our results suggest that benign nodular goiter disease does not pose significant challenges to intubation in our patient cohort. The technique of intubation deviated from the initial plan several times in the FOI group, whereas LTOI was ultimately successful in every case. Our data suggest that the role of fiberoptic intubation for patients with large goiters should be further refined.",
keywords = "Airway management, Airway obstruction, Endotracheal intubation, Goiter, Intubation, Nodular",
author = "Loftus, {Patricia A.} and Ow, {Thomas J.} and Bianca Siegel and Tassler, {Andrew B.} and Smith, {Richard V.} and Cohen, {Hillel W.} and Schiff, {Bradley A.}",
year = "2014",
doi = "10.1177/0003489414524171",
language = "English (US)",
volume = "123",
pages = "279--285",
journal = "Annals of Otology, Rhinology and Laryngology",
issn = "0003-4894",
publisher = "Annals Publishing Company",
number = "4",

}

TY - JOUR

T1 - Risk factors for perioperative airway difficulty and evaluation of intubation approaches among patients with benign goiter

AU - Loftus, Patricia A.

AU - Ow, Thomas J.

AU - Siegel, Bianca

AU - Tassler, Andrew B.

AU - Smith, Richard V.

AU - Cohen, Hillel W.

AU - Schiff, Bradley A.

PY - 2014

Y1 - 2014

N2 - Objective: The objective was to determine patient and gland characteristics associated with difficult intubation in patients undergoing thyroidectomy for goiter and to assess different methods of intubation in these patients. Methods: This study was an IRB-approved, retrospective chart review of 112 consecutive patients undergoing hemithyroidectomy or total thyroidectomy for thyroid goiter from 2009-2012 at an academic tertiary care facility in Bronx, New York. Patient demographics, thyroid gland characteristics (gland weight and nodule size), presence of preoperative symptoms (dyspnea, dysphagia, and hoarseness), and radiographical findings (tracheal compression, tracheal deviation, and substernal extension of the thyroid gland) were recorded. Anesthesia records were reviewed for method of intubation, as well as success or failure of intubation attempts. Results: Nineteen patients (17.0%) were men and 93 (83.0%) were women. The age of the patients included in the study ranged from 14 to 86 years with a mean ± SD age of 53.5 ± 14.7 years. Difficult intubation was noted with 13 (11.6%) patients. Only patient age was significantly associated with difficult intubation. The mean age of patients with airway difficulty was 60.7 ± 3.7 years compared to 52.1 ± 1.5 years in those who did not experience airway difficulty (P = .04). No other reviewed risk factors were found to be significantly associated with difficult intubation. Fiberoptic intubation (FOI) was used in 38 patients and difficult intubation occurred in 18.4% (7/38). Direct laryngoscopy with transoral intubation (LTOI) was used in 58 patients, in whom 3.4% (2/58) experienced a difficult intubation. FOI was aborted 6 times and LTOI was subsequently successful in each of these cases. Conclusions: Our results suggest that benign nodular goiter disease does not pose significant challenges to intubation in our patient cohort. The technique of intubation deviated from the initial plan several times in the FOI group, whereas LTOI was ultimately successful in every case. Our data suggest that the role of fiberoptic intubation for patients with large goiters should be further refined.

AB - Objective: The objective was to determine patient and gland characteristics associated with difficult intubation in patients undergoing thyroidectomy for goiter and to assess different methods of intubation in these patients. Methods: This study was an IRB-approved, retrospective chart review of 112 consecutive patients undergoing hemithyroidectomy or total thyroidectomy for thyroid goiter from 2009-2012 at an academic tertiary care facility in Bronx, New York. Patient demographics, thyroid gland characteristics (gland weight and nodule size), presence of preoperative symptoms (dyspnea, dysphagia, and hoarseness), and radiographical findings (tracheal compression, tracheal deviation, and substernal extension of the thyroid gland) were recorded. Anesthesia records were reviewed for method of intubation, as well as success or failure of intubation attempts. Results: Nineteen patients (17.0%) were men and 93 (83.0%) were women. The age of the patients included in the study ranged from 14 to 86 years with a mean ± SD age of 53.5 ± 14.7 years. Difficult intubation was noted with 13 (11.6%) patients. Only patient age was significantly associated with difficult intubation. The mean age of patients with airway difficulty was 60.7 ± 3.7 years compared to 52.1 ± 1.5 years in those who did not experience airway difficulty (P = .04). No other reviewed risk factors were found to be significantly associated with difficult intubation. Fiberoptic intubation (FOI) was used in 38 patients and difficult intubation occurred in 18.4% (7/38). Direct laryngoscopy with transoral intubation (LTOI) was used in 58 patients, in whom 3.4% (2/58) experienced a difficult intubation. FOI was aborted 6 times and LTOI was subsequently successful in each of these cases. Conclusions: Our results suggest that benign nodular goiter disease does not pose significant challenges to intubation in our patient cohort. The technique of intubation deviated from the initial plan several times in the FOI group, whereas LTOI was ultimately successful in every case. Our data suggest that the role of fiberoptic intubation for patients with large goiters should be further refined.

KW - Airway management

KW - Airway obstruction

KW - Endotracheal intubation

KW - Goiter

KW - Intubation

KW - Nodular

UR - http://www.scopus.com/inward/record.url?scp=84903522194&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84903522194&partnerID=8YFLogxK

U2 - 10.1177/0003489414524171

DO - 10.1177/0003489414524171

M3 - Article

VL - 123

SP - 279

EP - 285

JO - Annals of Otology, Rhinology and Laryngology

JF - Annals of Otology, Rhinology and Laryngology

SN - 0003-4894

IS - 4

ER -