Awake Fibreoptic Intubation
- Should be considered when there is concern regarding distorted upper airway anatomy or that the airway may be lost completely on induction
- Should not be performed in the setting of marked obstruction due to the risk of 'cork in bottle' phenomenon
Inhalational Induction and Intubation
- Provides an option for anxious patients intolerant of awake intubation
- Assessment needs to be made that the size of the goitre will no lead to obstruction after induction
- Difficult airway adjuncts must be available in case the airway is lost during induction
Awake Tracheostomy
- Provides a safe option if the above techniques are not possible
- The increased vascularity associated with a large goitre can make an awake tracheostomy difficult.
Rigid Bronchoscopy
- Provides a method for ventilation in the setting of unsuccessful intubation or subglottic tracheal compression