A `can't intubate, can't oxygenate' situation during an elective redo thyroid surgery; successful rescue and the lessons learnt

Pre-operative assessment of a patient for routine redo thyroidectomy requires a detailed airway assessment, clear documentation and formulation of an appropriate airway management plan by the anesthetist. Failure to identify problems related to oxygenation and ventilation during surgery will cause grave consequences to the patient and an unpleasant experience to the anesthetist and the surgeon. Redo thyroid surgery can be challenging. There is a possibility of preoperative vocal cord palsy due to previous surgical insult and infiltration by tumour recurrence, that can lead to difficulty in ventilation following induction of anesthesia. Therefore, it is mandatory to perform a detailed assessment of the airway using conventional as well as the advanced techniques. We report the lessons learnt from a 42-year-old, ASA I, male patient scheduled for a redo thyroidectomy who could not be intubated nor ventilated, following a "missed difficult airway," despite a clean history and the available past records. An emergency airway was declared and managed according to Difficult Airway Society (DAS) guidelines which finally resulted in a successful outcome. Subsequent evaluation by the ENT team revealed an absent glottic opening due to bilateral vocal cord palsy which resulted in a "can't intubate, can't oxygenate" state in this patient.