Jon McCormack

Editor—We read with great interest the article by Humphreys and colleagues1 and accompanying editorial2 describing the assessment of apnoeic times in children of different age groups using transnasal humidified high-flow nasal cannulae oxygenation (referred to as THRIVE). We note that the majority of the literature presented to date relates to prolonging apnoeic oxygenation time during induction of anaesthesia and intubation, particularly in patients at higher risk of hypoxaemia, such as children, those under critical care, and emergency intubations. Our institutional experience suggests that there is a significant group of paediatric patients who would benefit from THRIVE techniques, who were excluded from the study by Humphreys and colleagues,1 namely those with known airway abnormalities.

Summary: We describe a 2‐day‐old male infant who received rocuronium as part of general anesthesia for a tracheal esophageal fistula repair. Postoperatively, he had prolonged central and peripheral neuromuscular blockade despite cessation of the rocuronium infusion several hours previously. This case discusses the presumed central nervous system effects of rocuronium in a neonate and its effective reversal with sugammadex.