Correspondence  |   March 2019
Is a Single Dose of Propofol Good Enough to Prevent Respiratory Complications beyond the Induction Phase?
Author Notes
  • BP Koirala Institute of Health Sciences, Dharan, Nepal (A.S.). ashish.subedi@bpkihs.edu
  • (Accepted for publication November 19, 2018.)
    (Accepted for publication November 19, 2018.)×
Article Information
Correspondence
Correspondence   |   March 2019
Is a Single Dose of Propofol Good Enough to Prevent Respiratory Complications beyond the Induction Phase?
Anesthesiology 3 2019, Vol.130, 509-510. doi:10.1097/ALN.0000000000002576
Anesthesiology 3 2019, Vol.130, 509-510. doi:10.1097/ALN.0000000000002576
Ramgolam et al. reported that IV propofol, compared to sevoflurane induction, had protective effect against perioperative respiratory adverse events in high-risk children.1  The investigators also calculated the relative risk for perioperative respiratory adverse events adjusted for age, sex, American Society of Anesthesiologists Physical Status, and weight. However, we feel that other identified risk factors for perioperative respiratory adverse events, which include history of prematurity,2  obstructive sleep apnea,3  attempts at laryngeal mask airway insertion,4  and awake versus deep removal of laryngeal mask airway,4  were not mentioned.
Regarding the nonopioid analgesia, the children had received either regional or local analgesia. However, it is not clear whether the term “regional analgesia” means caudal analgesia or peripheral nerve blocks. The reason for highlighting this issue is that caudal analgesia has been reported to reduce the incidence of laryngospasm, although the mechanism is not clearly elucidated.5  Likewise, the authors have emphasized that the choice of opioid will have no impact on perioperative respiratory adverse events. However, it is evident that IV fentanyl is associated with coughing, the reported incidence of which is 46 to 60% in children.6  Compared to other opioids, morphine releases significant amounts of histamine, enough to trigger bronchospasm. Therefore, it might not be wise to use morphine in a child with hyperreactive airways when better options are available. It would be interesting to see the results if the analgesia is also considered as one of the independent variables in their analysis.