• Ana Cho, Seokhyung Hong, and Jinyoung So.
• Department of Anesthesiology & Pain Medicine, Soonchunhyang University Hospital Bucheon, Bucheon, Republic of Korea.
• J. Int. Med. Res. 2020 Jun 1; 48 (6): 300060520927875.

AbstractAirway management under anesthesia is given special attention in patients who have large goiters. Nasogastric tube insertion may be difficult in intubated patients with large goiters. Several methods have been proposed to facilitate the insertion of nasogastric tubes in patients with endotracheal intubation; however, a standard insertion method has not been established. A 33-year-old man was admitted to our otolaryngology department for right thyroid lobectomy to remove a larger goiter. A thyroid computed tomography scan revealed a huge cystic mass with tracheal displacement. Although difficult intubation was expected, endotracheal intubation was performed successfully. An anesthesiologist attempted nasogastric tube insertion via the right nostril; however, this was not successful. Next, an angiography catheter was placed in a nasogastric tube, and the nasogastric tube was gently inserted with the patient's neck in mild flexion. This attempt also failed. Finally, the nasogastric tube was gently inserted via anterior displacement of the cricoid cartilage. The nasogastric tube advanced up to 60 cm. Surgery was performed, and the patient was discharged with no complications on postoperative day 8.

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