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 

AuBuchon J, Krucylak C, Murray DJ: Subglottic airway foreign body: A near miss. ANESTHESIOLOGY 2011; 115:1300
Fehr JJ, Boulet JR, Waldrop WB, Snider R, Brockel M, Murray DJ: Simulation-based assessment of pediatric anesthesia skills. ANESTHESIOLOGY 2011; 115:1308–15
Litman RS, Ponnuri J, Trogan I: Anesthesia for tracheal or bronchial foreign body removal in children: An analysis of ninety-four cases. Anesth Analg 2000; 91:1389–91
Tomaske M, Gerber AC, Weiss M: Anesthesia and periinterventional morbidity of rigid bronchoscopy for tracheobronchial foreign body diagnosis and removal. Paediatr Anaesth 2006; 16:123–9
Chen LH, Zhang X, Li SQ, Liu YQ, Zhang TY, Wu JZ: The risk factors for hypoxemia in children younger than 5 years old undergoing rigid bronchoscopy for foreign body removal. Anesth Analg 2009; 109:1079–84
Fidkowski CW, Zheng H, Firth PG: The anesthetic considerations of tracheobronchial foreign bodies in children: A literature review of 12,979 cases. Anesth Analg 2010; 111:1016–25