AIRWAY COMPLICATIONS IN THYROID-SURGERY

Perioperative and postoperative morbidity and mortality were studied i n a series of 3,008 thyroidectomies. Compressive symptoms, frequent in substernal and cancerous goiters, were present in 11.0% of the patien ts, although a low rate of dyspnea (2.7%) was observed. In large goite rs, some orotracheal intubations were difficult. In such cases, the tr anstracheal approach can also be difficult, so failure should be antic ipated. Postoperative causes of respiratory obstruction included local hemorrhages, bilateral recurrent nerve palsies, and laryngeal edema. A tracheal collapse was not observed. These respiratory obstructions l ed to repeat surgery in 11 patients, tracheostomy in 3, and temporary reintubation with steroid therapy in 1. The recurrent laryngeal nerve, which may have been affected preoperatively, was found to be damaged postoperatively in 0.5% of the patients with benign goiters, compared to 10.6% of the patients with thyroid cancer. In this last group a bil ateral palsy was observed in 3 cases with prolonged or extensive surge ry. After these short-term orotracheal intubations (114 minutes on ave rage), injuries of the airway caused by the endotracheal tube were fou nd in 4.6% of the patients.