To the Editor:

—I read with great concern the recent editorial written by Dr. Benumof 1concerning preoxygenation, in which he states that “…the American Society of Anesthesiologists Difficult Airway Algorithm, which makes no mention of preoxygenation, should include a requirement for preoxygenation before the induction of general anesthesia whenever possible:obvious exclusion examples are very uncooperative adult patients and pediatric patients ” (my emphasis). It is not clear whether Dr. Benumof’s intention was to exclude all uncooperative patients, regardless of age, or whether he is suggesting that preoxygenation should not be performed in any child, even if the child is cooperative. Because young children desaturate more rapidly than adults, 2and because the value of preoxygenation in children has been shown, 3such a recommendation would seem unwise. Although my concern probably stems from the subtleties of the English language, I would ask Dr Benumof to clarify his meaning.

Benumof JL: Preoxygenation: Best method for both efficacy and efficiency? A nesthesiology 1999; 91:603–5
Patel R, Lenczyck M, Hannallah RS, Mcgill WA: Age and onset of desaturation in apnoeic children. Canadian J Anaesth 1994; 41:771–4
Videira RLR, Neto PPR, Amaral RVG, Freeman JA: Preoxygenation in children: For how long? Acta Anaesthesiol Scand 1992; 36:109–11