What are the key considerations in managing the airway in a post thyroidectomy haematoma?

  • Ensure appropriate support:
    • ENT surgeon on standby
    • Experienced anaesthetist
  • Anticipate and prepare for difficult airway:
    • Ensure smaller ETT than previously used
    • Have difficult airway trolley in close proximity
  • Consider options for securing the airway:
RSI with Direct / Videolaryngoscopy
Generally considered best option in most situations
Awake Tracheostomy
Often impractical with patient in extremis
Awake Fibreoptic intubation
Often impractical with patient in extremis
Inhalational Induction
Risks aspiration in patients that are not starved