A 77-year-old female, weighing 55 kg, height 161 cm and BMI of 21.21 presented with history of dry cough, breathlessness on exertion since five months, with history of swelling in the anterior aspect of neck, since 61 years. She was a hypertensive on amlong 5 mg OD and atenolol 50 mg OD and a known hyperthyroid, on neomercazole 5 mg OD since a month. There was no history of orthopnoea, stridor or change in voice. ABSTRACT Airway management of patients undergoing thyroidectomy for Retrosternal

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... itre (RSG) poses a unique challenge. Associated comorbidities, manipulation of the airway by the surgeons, airway compromise during induction, intubation, intraoperative and postoperative period can contribute to adverse events. We describe anaesthetic management of a patient with long standing goitre for 61 years with retrosternal extension with tracheal narrowing and compression for thyroidectomy. We secured the airway in an awake, spontaneously breathing patient under topical anaesthesia and sedation using direct laryngoscopy.