Endocrine Diseases and the Airway

Abstract

Airway management is the cornerstone of safe anaesthesia delivery. Endocrine disorders such as obesity, acromegaly, diabetes mellitus and thyroid disorders including goitre and malignancies may adversely affect the airway and increase the risk of difficult intubation. The aim of this . review is to focus on how these disorders may affect the airway and how they can be managed whether regarding predicting or overcoming any difficulty with airway management. Obesity: Morbid obesity is associated with a number of physiologic changes that increase the risk of anaesthesia and surgery. Obese patients have increased intraabdominal pressure, decreased functional residual capacity (FRC) and total lung capacity (TLC) which makes them more prone to hypoxia in the perioperative period. the obese patient with a large tongue, redundant folds of the oropharyngeal tissue is at risk to develop upper airway obstruction during anaesthesia. Obese patients are also at risk of regurgitation and aspiration. A short, thick, immobile neck produced by cervical fat pads will interfere with rigid laryngoscopy, irrespective of the patient's total body weight. Acromegaly: Acromegalic patients have coarse facial features which together with redundant oral, hypopharyngeal and may be laryngeal inlet may make mask ventilation difficult. Direct laryngoscopy is difficult in approximately 26% of acromegalic patients because of enlarged tongue, mandible and sometimes a huge epiglottis which can completely conceal the view.