Work

Anesthetic management of a patient with a giant goiter undergoing hip arthroplasty: A case report

Year: 2025

Type: article

Abstract: INTRODUCTION: This case report outlines the anesthetic management of a 73-year-old male with a giant multinodular goiter and uncontrolled hyperthyroidism undergoing hip arthroplasty. It highlights the challenges of balancing airway safety, endocrine stability, and surgical urgency in patients with anatomically complex goiters, emphasizing the role of multidisciplinary collaboration and spinal anesthesia as an alternative to high-risk general anesthesia. CASE PRESENTATION: The patient, refusing thyroidectomy and tracheostomy, presented with a displaced femoral neck fracture and severe tracheal narrowing. Preoperative optimization included methimazole and potassium iodide to stabilize thyroid function. Spinal anesthesia using hyperbaric bupivacaine, dexmedetomidine, and fentanyl achieved a T8 sensory block, enabling uneventful cemented bipolar hemiarthroplasty. Intraoperative hemodynamics remained stable, with no sedation or airway intervention required. DISCUSSION: Spinal anesthesia circumvented airway manipulation risks, while adjuncts prolonged analgesia without respiratory compromise. The multidisciplinary approach addressed conflicting priorities: endocrine stabilization, surgical urgency, and airway safety. Postoperative care adhered to Enhanced Recovery After Surgery (ERAS) principles, with early mobilization and non-opioid analgesia. The absence of thyroid storm or complications validated the protocol. CONCLUSION: This case demonstrates spinal anesthesia's efficacy in patients with giant goiters undergoing non-thyroid surgery, particularly when airway risks preclude general anesthesia. Success relied on interdisciplinary collaboration, preoperative optimization, and tailored pharmacology. Future research should explore standardized protocols for non-compliant patients and optimal adjunctive drug regimens in spinal anesthesia for high-risk populations.

Source: International Journal of Surgery Case Reports

DOI: 10.1016/j.ijscr.2025.111329

Authors: Alireza Shakeri, Mohsen Shojaeian, Elham Memary

Institutions: Imam Hossein Hospital, Shahid Beheshti University, Shahid Beheshti University of Medical Sciences

Language: English

Topic: Anesthesia and Pain Management

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,090