Correspondence  |   September 2017
In Reply
Author Notes
  • Weill Cornell Medicine, New York, New York. jhs2001@med.cornell.edu
  • (Accepted for publication June 1, 2017.)
    (Accepted for publication June 1, 2017.)×
Article Information
Correspondence
Correspondence   |   September 2017
In Reply
Anesthesiology 9 2017, Vol.127, 587-588. doi:10.1097/ALN.0000000000001763
Anesthesiology 9 2017, Vol.127, 587-588. doi:10.1097/ALN.0000000000001763
We thank Drs. Nghe and Godier for their constructive comments on our recent article1  as they point toward a useful alternative approach to the anesthetic problems seen during ophthalmic artery chemosurgery. However, we disagree with their conclusions.
We advocate using low-dose (0.5 to 1.0 μg/kg) intravenous epinephrine at the first sign of respiratory compromise during cannulation of the internal carotid or ophthalmic artery.1  The anesthetic is maintained using 1.0 to 1.2 minimum alveolar concentration (MAC) of sevoflurane during the cannulation process, which probably attenuates the hemodynamic changes one would otherwise expect from epinephrine. Typically, we see a 20 to 25% increase in heart rate and blood pressure lasting approximately 2 min, along with nearly instantaneous and complete correction of respiratory parameters. Most of these cases are performed in children aged 3 months to 6 yr. In the absence of underlying cardiac disease, we expect, and have found, this brief cardiovascular effect to be well tolerated. The duration of action of the single bolus of intravenous epinephrine neatly matches the expected duration of the respiratory compliance changes; both disappear simultaneously. We have found that since introducing early low-dose epinephrine to our protocol, the hypotension and bradycardia often seen during the ophthalmic artery cannulation process are rarely seen. It is possible that the epinephrine is treating both the respiratory and hemodynamic responses.
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