A combination of KingVision video-laryngoscope and flexible fibroscope for awake intubation in patient with laryngeal tumor — case report and literature review

Even though suxamethonium is not recommended in newborns, this does not mean it cannot be used in exceptional cases. George Meakin [3] has confirmed that the risk of side effects, such as tachycardia, bradycardia, hyperkalemia, increased intraocular pressure, myoglobinaemia or malignant hyperthermia in patients with muscular dystrophy, is high. For these reasons, in accordance with the FDA guidelines, the administration of suxamethonium in (all) children should be limited to emergency intubations, e.g. laryngeal spasm, full stomach, difficult airway. Similar recommendations have been proposed by the authors of the Consensus Statement discussed. We agree with the authors of the letter as to the risk of rapidly developing hypoxaemia, especially in the youngest patients. We cannot stay, however, indifferent to the risk of hyperoxaemia and complications related to it. Unfortunately, the overuse of very high concentrations of oxygen in all age groups is common. The toxicity of oxygen and its involvement in the development of retinopathy of prematurity and chronic lung disease have been frequently stressed in medical literature [4], whereas atelectasis resulting from pure oxygen ventilation has been excellently documented by Prof. Goran Hedenstiern. We are aware of continuous evolution of guidelines and opinions in all branches of medicine, including paediatric anaesthesiology. Our further task is to update the guidelines so that they reflect the current state of knowledge. We will take into account both the comments of the authors of the letter and the impatiently anticipated results of the recently completed APRICOT study, probably the biggest one in Europe, which assesses anaesthesiological procedures as well as the incidence and causes of complications of general anaesthesia in the European paediatric population.