Thoracic inlet X-ray in perioperative evaluation of endotracheal intubation difficulty and complications in patients with goiter

Abstract

In this study thoracic inlet X- ray, AP and lateral views was assessed in 100 patients with clinically confirmed goiter who underwent thyroidectomy to determine the value of this investigation in diagnosing upper airway obstruction, predicition of difficulty during anaesthetic induction and anticipation of postoperative necessity for ventilation support in these patients. It was combined with other preanasthetic and anaesthetic clinical tests such as malampatti and laryngoscopic grading for assessing the airway and laryngeal intubation as well This study showed that, conventional radiology is the accepted method for detecting upper airway abnormalities especially in patients with huge goiter with retrosternal extension. Thoracic inlet x-ray did not predict difficult endotracheal intubation in patients with thyroid enlargement, there were 5 patients who had difficult endotracheal intubation (DEI). It can be of help in prediction of adequacy of manual ventilation, 9 patients had inadequate ventilation. It anticipated postoperative ventilatry complications, 6 patients needed postoperative support, 4 of them were reintubated while two had tracheostomy. Conventional radiology still has a role in managing patients with goiter as far as it is simple, cheap and available. Combination of clinical examination and radiological investigations are important in assessing patients with goiter when they undergo thyroidectomy and might give an idea about difficulties during operation.