2025, Vol. 8, Issue 3, Part A

Background: Medullary thyroid carcinoma (MTC) poses significant anaesthetic challenges due to its potential for airway compression, vocal cord involvement, and the need for intraoperative nerve monitoring (IONM). A tailored anaesthetic approach is essential to ensure airway safety, hemodynamic stability, and optimal surgical conditions.
Case Presentation: We report the anaesthetic management of a 48-year-old euthyroid female with FNAC-proven MTC, presenting with anterior neck swelling, left vocal cord palsy, and tracheal deviation. Preoperative evaluation revealed adequate airway parameters and normal thyroid function. After securing two 20G IV lines and attaching standard ASA monitors with BIS, induction was done with fentanyl 100?mcg and propofol 100?mg. Intubation was performed via video laryngoscopy using a 6.5 mm ETT, following a single dose of atracurium (25?mg). Maintenance was with TIVA using TCI of propofol and remifentanil (Minto model), without inhalational agents or additional relaxants to preserve neuromuscular function for IONM. Balanced salt solution (Sterofundin^®) was used for fluid management. The patient remained hemodynamically stable and was extubated uneventfully.
Conclusion: A TIVA-based anaesthetic technique using propofol and remifentanil, along with cautious airway management and avoidance of muscle relaxants post-intubation, provides optimal conditions for safe airway control, nerve monitoring, and rapid recovery in complex thyroid surgeries involving medullary carcinoma.