Questioning Succinylcholine Usage in Grade IV (Difficult) Mask Ventilation.

摘要

We thankXue et al. and Shetty et al. for the interesting letters they sent in response to our recent article. We fully agree with the first remark by Xue et al. We did not provide the method of anesthesia induction used in our protocol. However, we thought our method was clear enough to prevent any doubt regarding the technique of induction. All the adult patients received intravenous boluses of appropriate dosage of opioids and hypnotic agents (in most cases sufentanil and propofol, respectively). In our country, inhalation-induction of anesthesia is not popular in adults. Moreover, all the patients received neuromuscular blocking agents. We deliberately standardized anesthesia procedure to prevent poor anesthesia quality affecting airway management quality. Facemask ventilation (FMV) was attempted only if anesthesia depth and apneic status were confirmed both clinically and instrumentally. We are confident that Xue et al. are fully aware of the methods we have used. Attempting FMV in a nonapneic patient would have been considered as a fault in our standards. In operating room settings, there are very few if any indications for FMV in nonapneic elective patients requiring tracheal intubation. Mechanically-assisted nonin-vasive facemask spontaneous ventilation has been used in some morbidly obese patients but only while awake. These patients were returned to mechanically noninvasive, fully controlled ventilation as soon as spontaneous ventilation ceased. Moreover, we believe that maintaining spontaneous ventilation at induction may correlate with poor anesthesia quality associated with maintained airway protective reflex that was shown to increase the difficulty of conventional airway management maneuvers. Because these reflexes are resistant to deepening of anesthesia, defense and protective reflex may persist after loss of spontaneous ventilation if muscle relaxants are not administered.3 These observations are strong arguments for managing the airway of patien...