In Reply:-Dr. Roth's recommendation that pacing esophageal stethoscope (Arzco Medical Systems, Inc.) may be used to monitor the ECG in patients with extensive burn injury is also a nice solution. It offers the additional advantage of the ability to pace the atrium should that need arise. However, I see two problems with it. (1) It is an expensive solution compared with what I have proposed. (2) It can be used in patients only after induction of anesthesia is accomplished as the probe has to be inserted into the esophagus. Because of this necessity, (as pointed out by the authors) baseline ECG monitoring of the patient before induction and during induction are not possible.

Dr. Borum's suggestion about the use of transesophageal pulse oximeter addresses the other issue of difficulty in monitoring oxygen saturation in these extensively burned patients. However, it does not address the issue raised by me, which is, monitoring the ECG in these patients.

The difficulty, in placement of esophageal probes in patients with extensive burns (who may have feeding tubes or nasogastric tubes) also has to be considered.

Ram S. Ravindran, M.D.

Department of Anesthesiology; Wishard Memorial Hospital; Indianapolis, Indiana

(Accepted for publication January 20, 1998.)