Anesthetic Management of a Patient with Retrosternal Goiter Using a Double-lumen Endotracheal Tube

Anesthetic management of patients with mediastinal masses remains a formidable challenge as acute cardiorespiratory decompensation may follow induction of anesthesia. In endemic goiter areas, 20% of the population over the age of 70 will have a retrosternal goiter. This group of patients is heterogeneous with respect to the clinical evolution as well as with their various types, sizes, and location of masses. The vital organs in the limited mediastinal space may be affected in different ways. Therefore, the respiratory and hemodynamic responses to anesthesia may vary among individuals. There are sporadic case reports which illustrate acute cardiorespiratory decompensation during the course of anesthesia due to tumor-related compression of mediastinal organs, resulting in life-threatening conditions and even fatal outcomes. We describe the anesthetic management of a patient with multinodular goiter with retrosternal and mediastinal extension posted for total thyroidectomy, who was successfully managed with a double-lumen endotracheal tube.