To the Editor:
In the December issue, AuBuchon et al. from the Washington University School of Medicine in an Images in Clinical Medicine presentation of a high tracheal foreign body noted that “First, spontaneous ventilation is recommended.”1This same assertion is made again later in that issue in a paper from the same institution describing pediatric perioperative scenarios for use in simulation where “maintenance of spontaneous ventilation” was considered the correct response for a scenario of airway foreign body.2These two would make it seem that this is a clear requirement for caring for these children. Would any of the authors care to address several papers that have shown no advantage to spontaneous ventilation (and with a significant incidence of conversion to controlled ventilation) in a review of 94 patients;3that concluded there was no advantage to the avoidance of muscle relaxants in a series of 287 cases (inactivity with inhalational agent and muscle relaxant was “imperative”);4that found there were more problems with spontaneous ventilation than controlled ventilation with the use of muscle relaxants in a series of 384 patients;5or that concluded in a literature review of almost 13,000 patients that there is no apparent reason to avoid muscle relaxants?6
