I read with great interest the short report published in the Images in Anesthesiology section about difficult intubation in a 2-yr-old patient with Ullrich congenital muscular dystrophy. This disease is well known to carry a risk of difficult intubation.2–6  The authors nicely described how they used a nasopharyngeal airway to administer a volatile anesthetic and oxygen through one nostril while performing nasotracheal fiberoptic intubation via the other. I am however surprised that the choice of the anesthetic agent(s) used was not discussed. Ullrich congenital muscular dystrophy indeed belongs to the subgroup of the collagen type 6–related myopathies occurring after a mutation of the COL6A1, COL6A2, or COL6A3 gene. Collagen type 6 is part of the large complex that anchors the basal lamina and the interstitium in muscle cells. The myopathy is probably caused by the...

You do not currently have access to this content.