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

## TL;DR

A 73-year-old man with a large thyroid tumor safely underwent hip surgery using spinal anesthesia instead of general anesthesia, avoiding airway risks.

## Contribution

Demonstrates successful spinal anesthesia in a high-risk giant goiter patient, avoiding general anesthesia and airway manipulation.

## Key findings

- Spinal anesthesia with hyperbaric bupivacaine, dexmedetomidine, and fentanyl provided stable hemodynamics and effective analgesia.
- Multidisciplinary planning and preoperative optimization enabled safe surgery without thyroidectomy or tracheostomy.
- Avoiding general anesthesia reduced airway risks and prevented complications like thyroid storm.

## Abstract

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.

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.

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.

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.

•Successful spinal anesthesia for a giant goiter patient undergoing hip arthroplasty•Multidisciplinary planning ensured airway safety and favorable surgical outcomes.•Dexmedetomidine and fentanyl prolonged spinal block duration with stable hemodynamics.•Avoidance of general anesthesia reduced airway manipulation risks.•Thorough preoperative evaluation prevented airway-related complications.

Successful spinal anesthesia for a giant goiter patient undergoing hip arthroplasty

Multidisciplinary planning ensured airway safety and favorable surgical outcomes.

Dexmedetomidine and fentanyl prolonged spinal block duration with stable hemodynamics.

Avoidance of general anesthesia reduced airway manipulation risks.

Thorough preoperative evaluation prevented airway-related complications.