Goldenhar Syndrome and Airway Management

Sir.—As an anesthesiologist who has had experience with three children with Goldenhar syndrome, I read with interest the article by Feingold and Baum in the February Journal (132:136-138, 1978). Whenever such a child is to be admitted for surgery, the anesthesiologist should be notified in advance since these children may be difficult (or impossible) to intubate. I suggest the following procedure: (1) Explain to the parents that a tracheotomy may be necessary, and obtain consent. (2) Have an experienced otorhinolaryngologist present during introduction who is gowned and gloved, with a tracheotomy set open and ready. (3) Induce anesthesia with a potent inhalation anesthetic (halothane or enflurane) and oxygen, thus omitting nitrous oxide to provide a high inspired oxygen concentration and avoid fixed agents, permitting the child to maintain his own airway. (4) Laryngoscope the patient under deep anesthesia without the aid of muscle relaxants. (5) If the vocal cords