I appreciate the constructive comments of Nguyen et al. with regard to the recent trial published by Ramgolam et al.1 and the accompanying editorial in Anesthesiology.2 I certainly agree with the observation that the work station used may have an impact on how long an inhalational induction would take, and this may have an impact on the likelihood of complications during induction; however, in this case it transpires that the researchers did not use a Draeger Primus (Draeger, Germany) for induction but, as is common in Australia, used a separate anesthesia system with a back bar that connected to a T-piece where wash-in times were minimal. This indeed should have been clarified in the paper. Apart from the work station, several other aspects of an inhalational induction may vary between practitioners, such as use of nitrous oxide, fresh gas flow, choice of circuit, and the degree of overpressure used. It is certainly plausible, but not definite, if or how these variations may have an impact on the risk of complications. Nevertheless, variations in practice that could plausibly impact research findings should always be considered when translating trial findings to practice.
The author declares no competing interests.