- Airway management for large retrosternal goitre is often difficult as there is the potential for difficult airway management at all stages:
- Bag valve mask ventilation
- Laryngeal mask ventilation
- Laryngoscopy and intubation
- Airway rescue with transtracheal access
- There is no gold standard method of managing the airway in this situation with significant differences in the approach taken by airway experts
- Options for initial airway management suggested:
- Awake fibreoptic intubation
- Inhalational induction
- Intravenous induction with fibreoptic or direct intubation using a small tracheal tube
- The use of rigid bronchoscopy as ‘Plan B’ to bypass the obstruction and provide jet ventilation was suggested as the best option by most experts
- Options for initial airway management suggested:
