To the Editor:

—The editorial by Benumof 1regarding preoxygenation cited pediatric patients as “obvious exclusion examples,” and suggesting that they were not candidates for preoxygenation before the induction of general anesthesia. On the contrary, neonates, infants, and children are at increased risk of hypoxemia because of smaller functional residual capacities, increased heart rates, and increased metabolic requirements compared with adults. The younger pediatric patient who presents for rapid sequence induction (e.g. , duodenal atresia) or suspected difficult intubation (e.g. , Pierre Robin anomalad) would certainly benefit from appropriate preoxygenation.

Several studies using pulse oximetry data have confirmed that these young patients tend to desaturate more quickly than adults. 2,3Notably, the time to desaturation is affected by younger age 4and recent upper respiratory infection 5—a common variable encountered in clinical pediatric anesthesia from September through April.

Such studies using oximetry 6,7and end-tidal oxygen assessment (“oxygraphy,” FeO2) 8,9have demonstrated that children do indeed benefit from appropriate preoxygenation, which prolongs the potential apneic interval, and that use of a tight-fitting mask for at least 1 min is both desirable and strongly recommended.

Benumof JL: Preoxygenation: Best method for both efficacy and efficiency (editorial)? Anesthesiology 1999; 91:603–5
Laycock GJA, McNichol LR: Hypoxaemia during induction of anaesthesia: An audit of children who underwent general anaesthesia for routine elective surgery. Anaesthesia 1988; 43:981–4
Dupeyrat A, Dubreuil M, Ecoffey C: Preoxygenation in children. Anesth Analg 1994; 79:1027
Cote’ CJ, Rolf N, Liu LMP, Goudsouzian NG, Ryan JF, Zaslavsky A, Gore R, Todres ID, Vassallo S, Polaner D, Alifimoff JK: A single-blind study of combined pulse oximetry and capnography in children. Anesthesiology 1991; 74:980–7
Kinouchi K, Fukumitsu K, Tashiro C, Takauchi Y, Ohashi Y, Nishida T: Duration of apnoea in anesthetized children required for desaturation of hemoglobin to 95%: comparison of three different breathing gases. Paediatr Anaesth 1995; 5:115–9
Videira RLR, Neto PPR, Gomide do Amaral RV, Freeman JA: Preoxygenation in children: How long? Acta Anaesthesiol Scand 1992; 36:109–11
Xue FS, Tong SY, Wang XL, Deng XM, An G: Study of the optimal duration of preoxygenation in children. J Clin Anesth 1995; 7:93–6
Butler PJ, Monro HM, Kenny MB: Preoxygenation in children using expired oxygraphy. Br J Anaesth 1996; 77:3333–4
Morrison JE, Collier E, Friesen RH, Logan L: Preoxygenation before laryngoscopy in children: how long is enough? Paediatr Anaesth 1998; 8:293–8