Editorial Views  |   June 2018
Induction of Anesthesia for Children: Should We Recommend the Needle or the Mask?
Author Notes
  • From the Royal Children’s Hospital, Parkville, Victoria, Australia.
  • Corresponding article on page 1065.
    Corresponding article on page 1065.×
  • Accepted for publication March 1, 2018.
    Accepted for publication March 1, 2018.×
  • Address correspondence to Dr. Davidson: andrew.davidson@rch.org.au
Article Information
Editorial Views / Pediatric Anesthesia
Editorial Views   |   June 2018
Induction of Anesthesia for Children: Should We Recommend the Needle or the Mask?
Anesthesiology 6 2018, Vol.128, 1051-1052. doi:10.1097/ALN.0000000000002207
Anesthesiology 6 2018, Vol.128, 1051-1052. doi:10.1097/ALN.0000000000002207
PREOPERATIVE discussions in pediatric anesthesia often include the anesthesiologist saying: “there are two ways to induce anesthesia in your child: with anesthetic gas through a mask, or giving an anesthetic drug through an intravenous line.” Not infrequently the parent will respond, “which is best?” Do we have the evidence to answer this simple question? In this issue, Ramgolam et al. report findings from a randomized controlled trial comparing intravenous and inhalational induction in children that are deemed to be at risk of developing perioperative respiratory complications.1  At-risk children are defined using data from the authors’ previous work2  and include children having at least two of the following: an upper respiratory tract infection in the previous 2 weeks, more than three episodes of wheezing in the last 12 months, wheezing at exercise, nocturnal dry cough, history of eczema, passive smoking, and two members of the family with atopic symptoms. Perioperative respiratory complications are defined as arterial oxygen desaturation less than 95%, severe coughing, airway obstruction, bronchospasm, laryngospasm, or postoperative stridor. They found that intravenous induction had about half the rate of respiratory complications (10.7% for intravenous vs. 26% for inhalational induction). To some extent it is not surprising that intravenous inductions have fewer complications. They are faster, and the child progresses rapidly through the excitement phases of light anesthesia. There is also no pungent gas to irritate the airway. Ramgolam et al.’s results are consistent with what we would expect from our basic understanding of anesthetic pharmacology. So, should we now respond to parents that intravenous induction is safer? Should all children now have intravenous inductions? Maybe, and maybe not.
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