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Correspondence |
Sherbrooke, Québec
To the Editor:
We read with interest the paper by Yamaguchi et al.1 concerning the establishment of an appropriate technique for high concentration induction of anesthesia with sevoflurane in the elderly. We have four comments.
The first one concerns the absence of preoxygenation. Although the benefit of preoxygenation remains to be demonstrated if a mixture of 100% O2 and sevoflurane is used for vital capacity induction like in the present study, we would suggest that the importance of preoxygenation at least before iv induction is widely accepted.2
The second comment concerns waste anesthetic gases during vital capacity induction. It is desirable to minimize exposure to trace anesthetic gases. The use of the SiBITM connector (Ventitech Medical Devices, Sherbrooke, Quebec, Canada) designed for vital capacity induction could be useful for both preoxygenation and reduction of waste anesthetic gases.3
Thirdly, opioids are useful to avoid cardiovascular responses to endotracheal intubation. Figures 1 and 2 do indicate a hemodynamic response to intubation in the three groups. Small doses of opioids could be useful to prevent such changes, but should be limited because of the possibility of bradycardia with higher doses of opioids and sevoflurane at vital capacity induction.4
Finally, we feel that time to loss of consciousness and time to disappearance of eyelash reflex are longer than generally observed in Groups II and III. We suggest that monitoring of those two times should be a continuous process, not an intermittent process at ten-second intervals.
References
1 Yamaguchi S, Ikeda T, Wake K, Okuda Y, Kitajima T. A sevoflurane induction of anesthesia with gradual reduction of concentration is well tolerated in elderly patients. Can J Anesth 2003; 50: 26–31.
2 Benumof JL. Preoxygenation: best method for both efficacy and efficiency? Anesthesiology 1999; 91: 603–5.[Medline]
3 Colas MJ, Tétrault JP, Dumais L, Truong P, Claprood Y, Martin R. The SiBITM connector: a new medical device to facilitate preoxygenation and reduce waste anesthetic gases during inhaled induction with sevoflurane. Anesth Analg 2000; 91: 1555–9.
4 Gravel NR, Searle NR, Taillefer J, Carrier M, Roy M, Gagnon L. Comparison of the hemodynamic effects of sevoflurane anesthesia induction and maintenance vs TIVA in CABG surgery. Can J Anesth 1999; 46: 240–6.
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