Tailored airway management for simultaneous thyroidectomy and tracheal stenosis tumour biopsy: navigating dual pathologies

Tracheal stenosis secondary to tumour presents potential airway complications such as bleeding, airway oedema, laryngospasm and bronchospasm secondary to airway irritation, and difficulty advancing the endotracheal tube through the slit-like diameter of the trachea lumen. We present a case with double pathology of goitre and intraluminal tracheal tumour for thyroidectomy and tumour biopsy. A multidisciplinary discussion was held preoperatively between the otorhinolaryngology surgeons, radiologist, and anaesthesiologists to define resectability and perioperative management. The awake fibreoptic intubation oral approach using a microlaryngoscopy tube size 5 with target-controlled infusion of remifentanil sedation was successful. The airway was anaesthetised with a sphenopalatine ganglion block, palatopharyngeal arch nerve block, nebulisation lignocaine, and spray-as-you-go lignocaine to obtund the pharyngeal and laryngeal reflexes. Post thyroidectomy,direct rigid laryngoscopy was performed for tumour biopsy. The patient was later admitted to the intensive care unit for postoperative ventilation and monitoring. We learned that there is no single universal airway technique for airway management as it should be tailored based on the individual patient’s airway pathology and comorbidities after careful perioperative discussion and airway planning.