Successful nasal intubation with a laryngeal nerve monitoring tube using bronchoscopy in a patient with plunging goiter: a case report

BMC Research Notes

Carlo A Volta¹  Riccardo Ragazzi¹  Marco Verri¹  Manuela D’Agata¹  Savino Spadaro¹ 

[1] Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care, S. Anna Hospital, University of Ferrara, via Aldo Moro 8 Cona, Ferrara, FE 44124, Italy

关键词: Thyroid surgery;    Fiberoptic bronchoscopy;    Recurrent laryngeal nerve monitoring;    Difficult airway;   

Others  :  1140823
DOI  :  10.1186/1756-0500-6-467

 received in 2013-07-16, accepted in 2013-11-12,  发布年份 2013

【 摘 要 】

Background

The appropriate positioning of nerve integrity monitoring during thyroid surgery is of relevance. In this case report we describe our experience with accurate placement of a nerve integrity monitoring endotracheal tube, obtained by fiberoptic control, in a patient with expected difficult airway management.

Case presentation

We report the case of a 70-year-old obese woman scheduled for elective total thyroidectomy due to plunging intrathoracic goiter. The preoperative indirect laryngoscopy pointed out a massive bombè of the hypopharyngeal wall to the right and right vocal cord paralysis. The epiglottis was oedematous and the glottis could not be identified. On physical examination, the tongue was large and a Mallampati’s score of 3 was determined. Hence, due to an expected difficult airway management, a nasal intubation with an electromyographic nerve integrity monitoring endotracheal tube trough fiberoptic bronchoscopy was successfully performed.

Conclusion

Our experience suggests that nasal intubation can be safely performed by using a nerve integrity monitoring tube with the help of fiberoptic bronchoscopy.

【 授权许可】

   
2013 Spadaro et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Machata AM, Gonano C, Holzer A, Andel D, Spiss CK, Zimpfer M, Illievich UM: Awake nasotracheal fiberoptic intubation: patient comfort, intubating conditions, and hemodynamic stability during conscious sedation with remifentanil. Anesth Analg 2003, 97(3):904-908.
• [2]Xue FS, Liao X, Zhang YM: Pathway of the tracheal tube and complications of nasal intubation. Br J Anaesth 2009, 102(2):282.
• [3]Gremillion G, Fatakia A, Dornelles A, Amedee RG: Intraoperative recurrent laryngeal nerve monitoring in thyroid surgery: is it worth the cost? Ochsner J 2012, 12(4):363-366.
• [4]Parmeggiani D, De Falco M, Avenia N, Sanguinetti A, Fiore A, Gubitosi A, Madonna I, Peltrini R, Ambrosino P, Parmeggiani U: NIM vs Neurosign in nerve sparing total thyroidectomy. Multicentric experience. Ann Ital Chir 2012, 83:233-238.
• [5]Randolph GW, Dralle H, Abdullah H, International Intraoperative Monitoring Study Group: Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope 2011, 121(Suppl 1):S1-S16.
• [6]Berkow L, Dackiw AP, Tufano RP: Use of the GlideScope for placement of a recurrent laryngeal nerve monitoring endotracheal tube. J Clin Anesth 2011, 23(1):81-83.
• [7]Kanotra SP, Kuriloff DB, Lesser J: GlideScope-assisted nerve integrity monitoring tube placement for intra-operative recurrent laryngeal nerve monitoring. J Laryngol Otol 2012, 126(12):1271-1273.
• [8]American Society of Anesthesiologists: Practice guidelines for management of the difficult airway. A report by the American society of anesthesiologists task force on management of the difficult airway. Anesthesiology 1993, 78(3):597-602.