CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Related articles in CJA
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Yamaguchi, S.
Right arrow Articles by Kitajima, T.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Yamaguchi, S.
Right arrow Articles by Kitajima, T.
Canadian Journal of Anesthesia 50:524-525 (2003)
© Canadian Anesthesiologists' Society, 2003

Correspondence

REPLY

Shigeki Yamaguchi, MD PhD, Tomofumi Ikeda, MD, Koji Wake, MD PhD, Yasuhisa Okuda, MD PhD and Toshimitsu Kitajima, MD PhD

Tochigi, Japan

We thank Colas et al.1 for their comments on our induction technique,2 whereby high concentrations of sevoflurane are inhaled initially and concentration is reduced gradually thereafter. We would like to respond and discuss their suggestions. First, they suggest that preoxygenation should be used before anesthesia induction. In our technique, preoxygenation was not used in order to simplify the technique for inhalation induction in the elderly. Although we did not use preoxygenation, serious desaturation was not observed in our patients. Benumof et al.3 reported an alternative technique for preoxygenation to increase arterial oxygen tension. However, because the circuit has to be primed with sevoflurane, an additional source of oxygen and anesthesia circuit will be necessary. Recently, Colas et al.4 reported the SiBITM connector can be useful for inhalation induction. It may not only facilitate preoxygenation, but also reduce waste anesthetic gases during inhalation induction. When the SiBITM connector becomes more widely available for inhalation induction, it will certainly improve inhalation induction in the elderly. Second, they suggest the use of small doses of opioids to prevent cardiovascular instability. The use of opioids has its merits and disadvantages in inhalation induction. The merit is to inhibit the stress response to intubation. The disadvantage is to depress cardiac function, especially in the elderly. At this time, the issue remains controversial. However, it should be noted that our inhalation induction technique, using a gradual reduction of concentration, resulted in cardiovascular stability during the induction of anesthesia in our elderly patient population.

References

1 Colas MJ, Martin R, Cardinal V. Sevoflurane induction of anesthesia in elderly patients (Letter). Can J Anesth 2003; 50:-524.[Free Full Text]

2 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.[Abstract/Free Full Text]

3 Benumof JL. Preoxygenation: best method for both efficacy and efficiency. Anesthesiology 1999; 91: 603–5.[Medline]

4 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.[Abstract/Free Full Text]


Related articles in CJA:

Sevoflurane induction of anesthesia in elderly patients
Marie-José Colas, René Martin, and Valérie Cardinal
CJA 2003 50: 524. [Full Text]  




This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Related articles in CJA
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Yamaguchi, S.
Right arrow Articles by Kitajima, T.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Yamaguchi, S.
Right arrow Articles by Kitajima, T.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS