Large Goiters Surgery and Intubation Conditions. Case Series from the Eastern Provinces of the Democratic Republic of Congo

Background: Airway management may be challenging in patients with large goiter especially in a limited resource environment. Objectives: To investigate if the presence of benign large goiters increases the risk of difficult intubation. The work was done in the Eastern provinces of the Democratic Republic of Congo. Methods: One hundred forty-seven patients scheduled for subtotal thyroidectomy were included. Experienced anaesthesiologists performed all intubations and scored the difficulties (Cormack-Lehane) and number of laryngoscopies. Results: We analyzed 136 females and 11 males [mean (SD) age 45.5 (10.4) years, weight 60.8 (12.1) kg, height 157.8 (7.5) cm] patients. Ninety-three were Mallampati class I, 39 class II, 13 class III, and 2 class IV. Mouth opening was >3.5cm in 141 cases and <3.5cm in 6 cases. The mean (SD) neck circumference was of 36.3 (2.9) cm. Dyspnea was present in 54 and dysphagia in 44 of patients. Clinical tracheal deviation was observed in 53 and a tracheal compression in 26 cases. One hundred thirtythree patients presented Cormack-Lehane grade I, 11 grade II, 2 grade III and 1 grade IV. In 133 cases tracheal intubation was achieved on first attempt, two were needed in 11 cases and up to four in 3 cases. No failed intubation was encountered. No correlation was found between goiter characteristics or Cormack-Lehane and number of laryngoscopies. Conclusion: A large goiter was not associated with an increased incidence of difficult laryngoscopy or intubation. Thus, no particular measures should be taken even in regard to a limited resource environment.