Awake Fiberoptic Intubation for Airway Management in a Patient With Multinodular Goiter and Severe Tracheal Stenosis

Managing difficult airways in patients with complex comorbidities and language barriers requires a strategic, multidisciplinary approach. We present the case of a 60-year-old non-smoking female with a history of multinodular euthyroid goiter causing significant tracheal stenosis, scheduled for an elective procedure. Her sole documented comorbidity was a newly diagnosed diabetes mellitus. No additional health conditions were reported. A notable challenge was the language barrier, as the patient did not speak the local language, necessitating the presence of a translator to facilitate all communication and informed consent. Given the significant tracheal compression observed in imaging studies, an awake fiberoptic intubation was planned to reduce airway compromise risks. This approach allowed for continuous patient cooperation and monitoring, minimizing the chance of sudden airway obstruction. Throughout the procedure, maintaining clear communication and patient cooperation was essential for the safe execution of the intubation. This case emphasizes the importance of thorough preoperative planning and individualized airway management strategies, particularly in patients with significant anatomical challenges. It highlights the need to adapt standard airway techniques to address complex physiological conditions and underscores the value of a methodical approach to ensure safe and successful outcomes in difficult airway cases.