Incidence of difficult intubation in thyroid gland reoperation due to bleeding or haematoma

Aleksandra Jukić¹, Suzana Krstić¹, Gordana Prvanović¹, 
Snežana Petrović¹, Ljubica Mitrović¹, Vera Vojinović¹

¹National Cancer Research Center, Department of Anaesthesiology and Intensive Care, Belgrade, Serbia

Emergency reoperation of thyroid gland due to bleeding and haematoma is a life threatening situation for patient which poses several problems for anesthesiologist. One of them is the difficulty in air management due to compression of trachea by haematoma which may result in reduction of tracheal lumen or tracheal dislocation, presence of blood in airway, significant edema of epiglottis, pharyngeal wall and the vocal cords. The aim of this study was to determine the incidence of difficult intubation during thyroid gland reoperation due to bleeding or haematoma in our center.
We conducted a retrospective study at the National Cancer research center of Serbia from January 1st, 2014 to June 31st, 2015. Data were obtained from medical records and patient histories. All patients who had a thyroid gland reoperation due to bleeding or haematoma during this period were included. Difficult laryngoscopy was defined according to Cormack and Lehane grade III and IV classification while difficult intubation according to ASA criteria. Data were analyzed using methods of descriptive statistics.
Thyroid gland operation in our center was performed in 1253 patients in the study period. Among them, 19 patients (73. 4 % women, median age 56 years) had a reoperation due to bleeding or haematoma in the first 24 hours. 8 (42.1 %) patients had skin sutures removed at bedside with evacuation of clot, due to the presence of stridor and/or hypoxia, before being transferred to operating room. Difficult laryngoscopy Cormack and Lehane grade III was encountered in 4 (21.0 %) patients, grade IV in 2 (10.5 %) patients, while difficult intubation occurred in 1 (5.3 %) patient.  There were no cases of unsuccessful intubation or the need for emergency tracheotomy. 
The fact that securing airway in case of a post-thyroidectomy haematoma may be very difficult even for an experienced anesthesiologist should always be kept in mind. Further research of means for dealing with this situation would be very helpful.

Incidence of difficult intubation in patients undergoing thyroid gland reoperation due to bleeding or haematoma