Anesthetic management of a patient with recurrent shock caused by anaplastic thyroid carcinoma compressing the internal carotid artery: a case report

Stimulation of baroreceptors in the carotid sinus may increase vagal activity and decrease sympathetic activity. In rare cases, this can lead to carotid sinus hypersensitivity, which may cause hypotension, bradycardia, or even asystole. An 86-year-old man scheduled for elective thyroid surgery was admitted to the emergency room with repeated episodes of syncope followed by shock. These episodes were suspected to be caused by metastatic lymph nodes compressing the carotid sinus. In the operating room, a video laryngoscope was used for the first laryngoscopy attempt to minimize neck extension. Endotracheal intubation was successful on the first attempt, and the patient remained hemodynamically stable. Excessive neck extension during laryngoscopy and positioning to optimize the surgical field may trigger carotid sinus hypersensitivity. Therefore, measures to minimize neck extension, including use of video laryngoscopy, and careful monitoring during patient positioning are recommended.