Dr.J.Edward Johnson M.D.

Long standing goitre – 15yrsLong standing goitre – 15yrs No history of airway obstruction or vocal No history of airway obstruction or vocal

cord palsycord palsy TFT normalTFT normal X-Ray neck & CT neck – no compression X-Ray neck & CT neck – no compression

& only slight Rt side deviation of trachea& only slight Rt side deviation of trachea DL scopy – vocal cords normalDL scopy – vocal cords normal Anaemic with mild cardiomegaly(Hb 9 Anaemic with mild cardiomegaly(Hb 9

gms%)gms%)

Mallampatti -class IIMallampatti -class II

Anticipated difficult air Anticipated difficult air way because of huge way because of huge goitre almost occupying goitre almost occupying whole neckwhole neck

For video follow the link;

http://www.youtube.com/watch?v=8wYZFZOf5uw

Trachemalacia – noted 3Hrs after Trachemalacia – noted 3Hrs after surgerysurgery

Intubated with 7 size ETT cuffedIntubated with 7 size ETT cuffed Large dose steroids givenLarge dose steroids given Trial extubation tried after 36Hrs.Trial extubation tried after 36Hrs. Patient went for stridor once again Patient went for stridor once again

and re-intubated with 6 size ETT and re-intubated with 6 size ETT cuffed.cuffed.

Tracheostimy done after 2 Hrs.Tracheostimy done after 2 Hrs.

• Incidence (Department of Endocrine Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, 226 014 Lucknow, India) - 1990–2005 - 28 patients treated for tracheomalacia

-Mean duration of thyroid enlargement - 13.75 years -7 patients had a history of stridor -Tracheostomy was performed in 26 patients 18 patients on the operating table

-The tracheostomy tube was removed after an average of 8.5 days.

On the basis of our experience we strongly advocate tracheostomy intraoperatively if the trachea is soft and floppy and/or collapse of the trachea is observed following gradual withdrawal of the endotracheal tube.