When managed within a dedicated H&N operating theatre we have found a low incidence of difficult tracheal intubation, difficult mechanical ventilation nor postoperative respiratory difficulties in patients with massive RSG and mid-tracheal compression because of benign multi-nodular goitre. Surgical complications, however, are more frequent than those associated with cervical thyroidectomy with RLN injury and postoperative bleeding more likely.

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Anaesthesia for massive retrosternal thyroidectomy in a tertiary referral centre Editor-We read the publication by Dempsey and colleagues 1 with interest. We have a few questions about the report which we hope the authors can clarify. First, what events actually occurred surrounding the one case of failed intubation. If we followed correctly, they were the only patient undergoing an inhalation induction. What prompted the change from i.v. induction? Do the authors think that this influenced events? Secondly, regarding laryngoscopy and intubation, was there a poor view or was the view good but passing the tube impossible? Does the case in Table 3 marked as failed under laryngoscopy equate to a grade 4 view and is this the case in question? Thirdly, in the discussion, the authors make reference to a low incidence of difficult intubation. Is one in 20 (5%) not regarded as a high incidence? We would be grateful for more information regarding these difficult cases, so we can learn further from others' experience.