Remifentanil PCA in labour

tinct lumens.” Our initial plan was to perform thyroidectomy in cardiac theatre with large femoral lines in place and cardiac bypass immediately available. However, the dyspnoeic symptoms had resolved and with the reassuring prone CT (Fig. 3), surgery was undertaken in the general theatre suite. Anaesthesia was induced and maintained in our standard way with remifentanil and propofol target-controlled infusions and rocuronium to facilitate tracheal intubation. Total thyroidectomy proceeded uneventfully. Although similar use of prone CT has been published [1], we believe this is the first description of the merits of this intervention in the acute peri-operative period. Difficult intubation in thyroid surgery is no more common than in the general population [2], and the majority of case reports describe awake fibreoptic intubation or use of guidewire/airway exchange catheter [3]. However there are contraindications to fibreoptic intubation, e.g. patient refusal and allergy to local anaesthetic [4]. There is a paucity of robust evidence in the medical literature to guide individual cases such as this and expert opinion varies considerably [5]. Our case demonstrates that prone CT is a useful addition to the armamentarium of investigations.