Tracheal elastic recoil-induced carinal shift causing intraoperative hypoxemia after resection of massive substernal goiter: A case report.
- 1Department of Anesthesiology, Yichang Central People's Hospital, The First College of Clinical Medicine Science, China Three Gorges University, Yichang, Hubei, China.
- 2Department of Anesthesiology, The Eighth Hospital of Wuhan, Wuhan, Hubei, China.
Abstract
A large substernal goiter can severely compress and displace the trachea, complicating airway and anesthetic management. We report a 61-year-old deaf-mute man with a giant substernal goiter causing critical tracheal stenosis (6 mm diameter, 2.7 cm length). Awake intubation was successfully achieved using a combined videolaryngoscope-fiberoptic bronchoscope technique. Following resection of the left thyroid lobe, the patient developed refractory hypoxemia (SpO₂ 85%) unresponsive to standard interventions. Stepwise withdrawal of the endotracheal tube by 1 cm improved oxygenation from 90% to 97%. This finding suggests a novel mechanism of ventilation-perfusion mismatch: Post-resection tracheal elastic recoil and shortening led to cephalad carinal shift relative to the fixed tube, resulting in functional malposition and unilateral ventilation. This case highlights the importance of dynamic monitoring and timely adjustment of endotracheal tube position during procedures that alter airway anatomy.
Related
- The application of tubeless anesthesia technique in tracheal tumor resection surgery: a case report
- Classification of tracheal and crico-tracheal resection and anastomosis: a proposal from the European Laryngological Society.
- Emergency Tracheal Resection and Anastomosis for Life-Threatening Intratracheal B-Cell Lymphoma in a Cat: A Case Report.
- The Role of Intraoperative Indocyanine Green Fluorescence Angiography in Reducing Anastomotic Leak After Colorectal Resection: A Systematic Review of Randomised Controlled Trials
- Intraoperative recall of surgeon-defined 3-dimensional planning during robotic pulmonary resection: A feasibility study
BibTeX
@article{li2026tracheal,
title = {{Tracheal elastic recoil-induced carinal shift causing intraoperative hypoxemia after resection of massive substernal goiter: A case report.}},
author = {Zixuan Li and Xue Yi and Shaojie Yang and Xiaobo Chen},
journal = {Saudi journal of anaesthesia},
year = {2026},
month = oct,
doi = {10.4103/sja.sja_403_26},
url = {https://europepmc.org/article/MED/42960052},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Tracheal elastic recoil-induced carinal shift causing intraoperative hypoxemia after resection of massive substernal goiter: A case report.
AU - Zixuan Li
AU - Xue Yi
AU - Shaojie Yang
AU - Xiaobo Chen
PY - 2026
DA - 2026/10/01
JO - Saudi journal of anaesthesia
DO - 10.4103/sja.sja_403_26
UR - https://europepmc.org/article/MED/42960052
AB - A large substernal goiter can severely compress and displace the trachea, complicating airway and anesthetic management. We report a 61-year-old deaf-mute man with a giant substernal goiter causing critical tracheal stenosis (6 mm diameter, 2.7 cm length). Awake intubation was successfully achieved using a combined videolaryngoscope-fiberoptic bronchoscope technique. Following resection of the left thyroid lobe, the patient developed refractory hypoxemia (SpO₂ 85%) unresponsive to standard interventions. Stepwise withdrawal of the endotracheal tube by 1 cm improved oxygenation from 90% to 97%. This finding suggests a novel mechanism of ventilation-perfusion mismatch: Post-resection tracheal elastic recoil and shortening led to cephalad carinal shift relative to the fixed tube, resulting in functional malposition and unilateral ventilation. This case highlights the importance of dynamic monitoring and timely adjustment of endotracheal tube position during procedures that alter airway anatomy.
SN - 1658-354X
SN - 0975-3125
ER -