Introduction: The term "goitre" describes an abnormal thyroid gland enlargement. Goiter  prevalence ranges from 80% in iodine-deficient regions and 1%–4% in areas of affluent countries  with abundant iodine. We anaesthesiologist face airway challenges while treating patients  with severe neck swellings because tracheal intubation failure can have serious consequences  for morbidity and mortality.

Case Report: In this case we present a 40-year-old male which is a case of colloid goitre  posted for total thyroidectomy. Pre anaesthetic evaluation done, shifted to OT, pre-medicated  with standard drugs. Difficult bag and mask ventilation were faced during pre-oxygenation.  Hence Awake VLS was done to visualize vocal cords. Patient was induced with standard drugs  and VLS with Bougie assistance airway was secured with ET tube 8mm ID. Intraoperative  vitals stable, Patient reversed after assessing all the extubation criteria. Patient extubated and  shifted to post-op ward. Patient got discharged under stable condition on POD 14.

Conclusion: In patients with goitres, difficult airways can be managed using a variety of  strategies. We can proceed with conventional airway management if all the airway examination  is within normal limits, and there is no tracheal compression or deviation. Awake intubation  with video laryngoscopy is an ill-defined notion that largely depends on individual preference.  In this case we have managed a case of neck swelling with awake VLS intubation.