Selection of appropriate size endotracheal tube in cases of large goiters causing tracheal compression.

Tracheal compression due to any cause can lead to difficulty in either ventilating or intubating the patient. Most often, it is due to a large thyroid swelling. Often the anesthetist is completely guided by the radiological findings to plan the airway management, giving much less importance to the patient's clinical picture. We report two cases of large multinodular goiter that caused tracheal compression without any symptoms of breathing difficulty in the patients. In both the cases we were able to pass larger size endotracheal tubes beyond the site of compression without any resistance. The external diameter of the endotracheal tubes were much larger than the diameter at the narrowest part of the airway measured by computerized tomography. We conclude that along with the extent of tracheal compression, its cause and site is of paramount importance in anesthetic planning and management of airway. A thorough history on the severity of patient symptoms due to the swelling is also important.