An assessment of the impact of large goitres on perioperative and postoperative airway management: a retropsective review

 

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dc.contributor.advisor Haylett, Revyl en_ZA
dc.contributor.advisor James, Michael F M en_ZA
dc.contributor.author Golding, Tarryn en_ZA
dc.date.accessioned 2018-02-06T14:14:06Z
dc.date.available 2018-02-06T14:14:06Z
dc.date.issued 2017 en_ZA
dc.identifier.citation Golding, T. 2017. An assessment of the impact of large goitres on perioperative and postoperative airway management: a retropsective review. University of Cape Town. en_ZA
dc.identifier.uri http://hdl.handle.net/11427/27329
dc.description.abstract It is widely assumed in the literature that large thyroid goitres pose a significant risk to the airway perioperatively. They are of concern to anaesthetists because of anticipated difficulty relating to intubation, ventilation and post-thyroidectomy tracheomalacia. They are of concern to surgeons because of the anticipated risk of difficult dissection and increased risk of surgical complications including haemorrhage, laryngeal nerve injury and tracheomalacia. Objectives: To analyse the folders of patients who have undergone anaesthesia and surgery for large, nonmalignant goitre, to assess the impact of large goiters on perioperative and postoperative management. An attempt will also be made to identify possible predictive markers/ patient characteristics associated with difficult intubation. Design: A retrospective folder review Setting: Groote Schuur Hospital Participants: All patients who had thyroidectomies performed at Groote Schuur Hospital between Jan 2010 and June 2016 for large, non-malignant goitres. Measurements and main results: Of the patients who underwent a thyroidectomy procedure at Groote Schuur Hospital between Jan 2010 and June 2016, 196 were identified as having non-malignant goitre and size in one dimension of greater than fifty millimeters. There were seven documented difficult intubations and only one case of failed intubation. This case was subsequently put onto cardiopulmonary bypass and intubated successfully using a rigid fibreoptic bronchoscope. Of the one hundred and nighty-six cases, four were intubated using a fibreoptic bronchoscope, eight with a videolaryngoscope, and six cases, a bougie. All other patients underwent uneventful tracheal intubation via direct laryngoscopy. All glands were removed via a collar incision with no requirement to proceed to sternotomy. There was only one patient requiring blood intraoperatively and only four reported cases of postoperative haematomas. There were no instances of tracheomalacia. Two patients suffered long term recurrent laryngeal nerve injury with voice changes. Conclusion: The data shows that, in patients with large, benign goitre undergoing thyroidectomy, airway difficulties at intubation and surgical and anaesthetic complications postextubation are rare. Intravenous induction and direct laryngoscopy is a safe technique in appropriately experienced hands. en_ZA
dc.language.iso eng en_ZA
dc.subject.other Anaesthesia en_ZA
dc.title An assessment of the impact of large goitres on perioperative and postoperative airway management: a retropsective review en_ZA
dc.type Master Thesis
uct.type.publication Research en_ZA
uct.type.resource Thesis en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Department of Anaesthesia en_ZA
dc.type.qualificationlevel Masters
dc.type.qualificationname MMed en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Golding, T. (2017). <i>An assessment of the impact of large goitres on perioperative and postoperative airway management: a retropsective review</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Anaesthesia. Retrieved from http://hdl.handle.net/11427/27329 en_ZA
dc.identifier.chicagocitation Golding, Tarryn. <i>"An assessment of the impact of large goitres on perioperative and postoperative airway management: a retropsective review."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Anaesthesia, 2017. http://hdl.handle.net/11427/27329 en_ZA
dc.identifier.vancouvercitation Golding T. An assessment of the impact of large goitres on perioperative and postoperative airway management: a retropsective review. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Anaesthesia, 2017 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/27329 en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Golding, Tarryn AB - It is widely assumed in the literature that large thyroid goitres pose a significant risk to the airway perioperatively. They are of concern to anaesthetists because of anticipated difficulty relating to intubation, ventilation and post-thyroidectomy tracheomalacia. They are of concern to surgeons because of the anticipated risk of difficult dissection and increased risk of surgical complications including haemorrhage, laryngeal nerve injury and tracheomalacia. Objectives: To analyse the folders of patients who have undergone anaesthesia and surgery for large, nonmalignant goitre, to assess the impact of large goiters on perioperative and postoperative management. An attempt will also be made to identify possible predictive markers/ patient characteristics associated with difficult intubation. Design: A retrospective folder review Setting: Groote Schuur Hospital Participants: All patients who had thyroidectomies performed at Groote Schuur Hospital between Jan 2010 and June 2016 for large, non-malignant goitres. Measurements and main results: Of the patients who underwent a thyroidectomy procedure at Groote Schuur Hospital between Jan 2010 and June 2016, 196 were identified as having non-malignant goitre and size in one dimension of greater than fifty millimeters. There were seven documented difficult intubations and only one case of failed intubation. This case was subsequently put onto cardiopulmonary bypass and intubated successfully using a rigid fibreoptic bronchoscope. Of the one hundred and nighty-six cases, four were intubated using a fibreoptic bronchoscope, eight with a videolaryngoscope, and six cases, a bougie. All other patients underwent uneventful tracheal intubation via direct laryngoscopy. All glands were removed via a collar incision with no requirement to proceed to sternotomy. There was only one patient requiring blood intraoperatively and only four reported cases of postoperative haematomas. There were no instances of tracheomalacia. Two patients suffered long term recurrent laryngeal nerve injury with voice changes. Conclusion: The data shows that, in patients with large, benign goitre undergoing thyroidectomy, airway difficulties at intubation and surgical and anaesthetic complications postextubation are rare. Intravenous induction and direct laryngoscopy is a safe technique in appropriately experienced hands. DA - 2017 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2017 T1 - An assessment of the impact of large goitres on perioperative and postoperative airway management: a retropsective review TI - An assessment of the impact of large goitres on perioperative and postoperative airway management: a retropsective review UR - http://hdl.handle.net/11427/27329 ER - en_ZA


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