Haematoma after thyroid surgery can lead to airway obstruction and death. We therefore developed guidelines to improve the safety of peri-operative care of patients undergoing thyroid surgery. We conducted a systematic review to inform recommendations, with expert consensus used in the absence of high-quality evidence, and a Delphi study was used to ratify recommendations. We highlight the importance of multidisciplinary team management and make recommendations in key areas including: monitoring; recognition; post-thyroid surgery emergency box; management of suspected haematoma following thyroid surgery; cognitive aids; posthaematoma evacuation care; day-case thyroid surgery; training; consent and pre-operative communication; postoperative communication; and institutional policies. The guidelines support a multidisciplinary approach to the management of suspected haematoma following thyroid surgery through oxygenation and evaluation; haematoma evacuation; and tracheal intubation. They have been produced with materials to support implementation. While these guidelines are specific to thyroid surgery, the principles may apply to other forms of neck surgery. These guidelines and recommendations provided are the first in this area and it is hoped they will support multidisciplinary team working, improving care and outcomes for patients having thyroid surgery.

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A modified naso-endotracheal tube is described which facilitates prolonged intermittent positive pressure ventilation of the lungs in infants and children. A crosspiece allows connection widi the inspiratory and expiratory tubes of a drcle-type mechanical ventilator. The technique of intubation and of securing ths nasal tube to the patient is described in detaiL The tube has been used in 126 patients for periods of up to three months. Subglottic stenosis developed in two patients. It is provisionally recommended that the duration of intubation should not exceed three weeks.

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