Freeman‐Sheldon syndrome

SIR—I read with interest the case report by Agritimis et al. (1) concerning anesthesia in a child with Freeman–Sheldon syndrome. The authors add another case to those that have been published (2–9). I have a few concerns about their report. First, they make a point of cancelling the case the first time the child was scheduled because of a chest infection and a report of respiratory complications in a child with this syndrome. However, any child with an acute infection should be treated for the infection prior to any elective surgery. Second, they state that because of the present of a cleft palate, they could not use an LMA. The LMA has been used successfully as an airway for cleft palate surgery (personal communication). My third concern is the assumption of a close association with malignant hyperthermia. Although there have been reports of such an event (3), the question is still unsettled. Numerous children with this syndrome have undergone anesthesia and many have undergone multiple surgeries without any episode of malignant hyperthermia (2, 4–9). The authors state that dantrolene was available in the operating room which apparently helped them to decide to use a potent inhalation anesthetic technique. Although dantrolene is present in all our operating rooms, this should not dictate the use of our anesthesia techniques. As a pediatric anesthesiologist who is often faced with anesthetizing children with rare and unusual syndromes, report of cases such as this adds to and helps our understanding. James F. Mayhew Anesthesiology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216-4505, USA (email: rejfm@hotmail.com) References