Correspondence  |   March 2019
Other Factors Affect the Occurrence of Perioperative Respiratory Adverse Events
Author Notes
  • Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.D.). dengxiaoming2003@sina.com
  • (Accepted for publication November 19, 2018.)
    (Accepted for publication November 19, 2018.)×
Article Information
Correspondence
Correspondence   |   March 2019
Other Factors Affect the Occurrence of Perioperative Respiratory Adverse Events
Anesthesiology 3 2019, Vol.130, 507-508. doi:10.1097/ALN.0000000000002574
Anesthesiology 3 2019, Vol.130, 507-508. doi:10.1097/ALN.0000000000002574
With great interest, we read the article by Ramgolam et al., which reports inhalational versus IV induction of anesthesia in children with a high risk of perioperative respiratory adverse events.1  In addition to the limitations described in the discussion, we noticed other questions that may have influenced their findings.
First, it may be not in the interest of patients because preoxygenation was not routinely used, but preoxygenation should and could be used. It is well known that preoxygenation can delay the onset of apnea-induced arterial oxyhemoglobin desaturation.2–4  Because the “cannot intubate, cannot ventilate” situation is unpredictable, the need for preoxygenation is desirable in all patients.5,6  Preoxygenation should be performed, especially in high-risk patients.7  Although all children in this study were high-risk patients, only children with at least two clinically relevant risk factors for perioperative respiratory adverse events could be recruited.1  Also, the children were given up to 66% N2O in oxygen for 20 s to 30 s before sevoflurane; the time was nearly adequate for deep breathing preoxygenation.1  Maximal preoxygenation (ETo2 = 90%) can be accomplished in children faster than in adults; with tidal volume breathing, an ETo2 of 90% can be reached within 100 s in almost all children, which could be shortened to 30 s with deep breathing.8,9