PREVENTIVE BOUGIE PLACEMENT IN TREATING ASPHYXIA CAUSED BY HEMATOMA AFTER THYROIDECTOMY: A CASE REPORT AND LITERATURE REVIEW

Qingxiang Cai¹, Wuhua Ma¹, Caineng Wu¹, Feng Li¹, Guangfang Zhang^{2, *}

¹Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China, 510405 - ²Department of pain, Guangdong Provincial Hospital of Chinese medicine, Guangzhou, China, 510120

Introduction: Dyspnea and asphyxia caused by incision hemorrhage after thyroid surgery is the most serious complication of thyroidectomy. It can be fatal if no proper measure is taken in time.

Case presentation: A 76-year-old woman was admitted to our hospital due to anterior cervical swelling. The disease has lasted for more than 40 years and swelling has been progressive enlargement in the past three months. Preoperative evaluation of airway showed that the anterior cervical swelling was of significant size and located in the center of the trachea. After thyroidectomy, we found that airway was partly blocked and jaw was clenched. Therefore, PFTT was directly re-intubated over the elastic bougie and mechanical ventilation was performed. After complete hemostatic treatment, the patient was kept intubated till the next day. No oozing of blood was observed. Both withdraw from the breathing machine and endotracheal extubation went well. 

Results: The patient achieved stability, and she was discharged from the hospital upon recovery after 7 days.

Conclusion: In conclusion, the anesthetist should be fully skillful to amicably address relevant postoperative complications during thyroidectomy. The key factors for the management of hemorrhage after thyroidectomy include close observation, early detection and airway management.