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GENERAL ARTICLES

Difficult Intubation in Thyroid Surgery: Myth or Reality?

R. Amathieu, MD, MS^*, N. Smail, MD, PhD, J. Catineau, MD^*, M. P. Poloujadoff, MD, MS^*, K. Samii, MD, PhD, and F. Adnet, MD, PhD^*

From *SAMU 93, EA 3409, Hopital Avicenne, University Paris, Bobigny, France; and Intensive Care and Anesthesia Department, Hopital Purpan, Toulouse, France.

Address correspondence and reprint requests to Roland Amathieu, MD, MS, SAMU 93 - EA 3409, 125, Route de Stalingrad, 93009 Bobigny Cedex, France. Address e-mail to roland.amathieu{at}jvr.aphp.fr.

Thyroid surgery is considered to be a risk factor for difficult airway management. We prospectively studied 324 consecutive patients undergoing thyroid surgery to investigate the incidence of difficult intubation as evaluated by the intubation difficulty scale as well as other specific predictive factors. The overall incidence of difficult intubation was 11.1% (95% CI: 7.6–14.5). Median intubation difficulty scale was 0 (25th–75th percentile: 0; 2.7). In three predefined groups (no echographic goiter, clinically palpable goiter, and impalpable goiter), difficult intubation occurred in 10% (95% CI: 4.8–17.4), 13% (95% CI: 6.5–18.4), and 11% (95% CI: 4.7–16.8) of patients, respectively, with no statistical difference among the groups. Specific predictive criteria (palpable goiter, endothoracic goiter, airway deformation, airway compression, or thyroid malignancy) were not associated with an increased rate of difficult intubation. Classical predictive criteria (mouth opening <35 mm, Mallampati III or IV, short neck, neck mobility <80°, thyromental distance <65 mm, and a retrognathic mandible) were significantly reliable in the univariate analysis as risk factors for difficult intubation.