Awake fiberoptic intubation in a patient with known difficult airway due to huge thyroid goiter

Thyroid enlargement or goiter has been considered a risk factor for difficulty in airway management during anaesthesia and surgery. Moderate to huge size along with retro-sternal extension makes it an anticipated difficult airway scenario. In this report, we present a case of huge goiter with compression symptoms and patient cannot be intubated by conventional direct laryngoscopy at a district hospital a week ago. CT scan revealed extension of mass into superior mediastinum compressing right brachiocephalic vein and superior vena cava. We successfully performed awake fiberoptic intubation with local/topical anaesthesia of airway. We have discussed the significance of careful approach, planning and preparation in the management of such a case.