Paralytic Agents for Intubation in the Out-of-Hospital Setting

Abstract

freezing to cryopreservation by vitrification and suggest this may be relevant for the interpretation of our study. 1 We agree that the different methods may have dissimilar effects on the children born after frozen embryo transfer. On the one hand, both procedures include the use of cryoprotectants, the freezing and thawing of embryos, and different protocols for the use of fertility drugs compared with fresh embryo transfer. 2,3 On the other hand, the 2 methods differ in the type and amount of cryoprotectants used, cooling rates, and the stage at which embryos are cryopreserved. 2 Whether vitrification is associated with cancer risk in children differently than cryopreservation by slow-rate freezing will depend on the underlying mechanisms leading to the increased risk.Hence, further studies are needed, both to confirm our results and to clarify the potential mechanisms that may lead to an increased risk of childhood cancer after frozen embryo transfer. Studies on the underlying mechanisms may advance understanding of why childhood cancer occurs, even in a broader perspective than associated with fertility treatment. Furthermore, because vitrification is a relatively new procedure, epidemiological studies on a specific health effect are limited by the small number of children born following the procedure, especially when studying rare outcomes such as childhood cancer. With time, more children will be born following vitrification and future well-powered epidemiological studies will help clarify whether childhood cancer or any other health effects are associated with the specific procedures.In Denmark, vitrification was introduced in 2006. 4 In our study, 3356 children were born following frozen embryo transfer. Of these, 1501 children (45%) were born before 2007 and 1855 (55%) were born from 2007 onward with 8 (0.58%) and 6 (0.32%) children developing cancer during the 2 periods. Of the 6 children born during the most recent period, 1 child was born after slow-rate freezing whereas information on the specific cryopreservation procedure was missing for the remainder of the children developing cancer. Hence, as Parmegiani and Vajta correctly state, our results are mainly based on children born after slow-freeze cryopreservation, although these numbers should be interpreted with caution because they do not take into account the length of follow-up (ie, shorter follow-up for more recent procedures). Future studies will clarify whether our results also reflect risks associated with vitrification.

Sugammadex in Emergency Situations

“…In the emergency department setting, rocuronium 1 mg/kg was as successful as succinylcholine for first-attempt emergency intubation, but succinylcholine had more contra indications such as hyperkaliemia, known cholinesterase deficiency, recent burns, or muscle myopathies [ 39 ]. These results have also been confirmed in a French multicentric randomized trial for out-of-hospital emergency intubations [ 40 ].…”