Background-Goiter or thyromegaly is one of the most common causes of mid tracheal obstruction (external compression or stenosis), which may be associated with difficult larynx visualization and/or difficult airway management during anesthesia depending on the goiter size, type and ingrowth into the surrounding tissue. Anesthetic management of patient’s remains challenging as acute airway complication may occur both during induction and recovery from anesthesia.

We report a case of 68 year old lady with recurrent benign cervical multinodular goiter who had underwent Left hemi-thyroidectomy 20yr back hascome with complaints of swelling over right side for Debulking Sx. There was evidence of tracheal narrowing so awake nasal fiber optic intubation was performed with 7.5 mm ID cuffed size endotracheal tube (ETT). The tumor was successfully removed via cervical approach. After careful assessment patient was electively ventilated postoperatively and extubated using fiber optic successfully on post-operative day 2 after demonstration ofsuccessful leak test around trachea following tracheal tube cuff deflation.

t is to emphasis that difficult airway not only includes Intubation but safe extubation also.

Multinodular goiter, Fiber optic intubation; Difficult airway; Trachealnarrowing.