Newly Published
Correspondence  |   August 2019
Neurologic Examination for Anesthesiologists: Comment
Author Notes
  • University of Edinburgh, Edinburgh, United Kingdom. g.b.drummond@ed.ac.uk
  • (Accepted for publication July 11, 2019.)
    (Accepted for publication July 11, 2019.)×
Article Information
Correspondence
Correspondence   |   August 2019
Neurologic Examination for Anesthesiologists: Comment
Anesthesiology Newly Published on August 19, 2019. doi:10.1097/ALN.0000000000002912
Anesthesiology Newly Published on August 19, 2019. doi:10.1097/ALN.0000000000002912
Reshef et al.1 describe neurologic events during induction of anesthesia to explain the relevant central reflexes. They describe that when giving a hypnotic drug as an IV bolus during a period of 5 to 10 s, the patient becoming unresponsive, atonic, and apneic follows rapidly. They attribute the apnea to anesthetic acting at “[γ-aminobutyric acid–mediated] synapses in the ventral and dorsal respiratory groups of the pons and medulla,” and support this by citing a detailed and comprehensive review that discusses the central rhythm generators for respiration.2  However, this review expressly excludes consideration of factors such as afferent modulation (such as chemosensors). In the conditions described by Reshef et al.,1  afferent modulatory factors, such as carbon dioxide and consciousness, are very relevant.