In Response

Abstract

In Response W e appreciate the comments from Nause-Osthoff et al 1 regarding our recent article on the perioperative management of patients with cystic fibrosis that was published in Anesthesia and Analgesia. 2 We agree with them that propofol is superior to volatile anesthetics at blunting airway reflexes, and therefore, propofol is commonly used in patients with cystic fibrosis for induction, maintenance of general anesthesia, or to supplement a general anesthetic with volatile agents for short procedures, such as bronchoscopy, central venous access, sinus surgery, etc. We also agree that desflurane would be a poor choice as it has been shown to cause bronchoconstriction and increase airway resistance in children with bronchial hyperreactivity, such as asthma, recent upper respiratory infections, and cystic fibrosis. 3 However, sevoflurane causes moderate bronchodilation and decreases airway resistance in both children and adults with airway susceptibility. [3][4][5] As mentioned by Nause-Osthoff et al, we are not aware of any clinical studies that directly compared outcomes between sevoflurane and total intravenous anesthesia with propofol and remifentanil in patients with cystic fibrosis.We postulate that bronchodilation and blunting of airway reflexes are clinically more important than the effects of anesthetics on bronchial mucus transport velocity, especially with short exposures. The clinical studies cited by Nause-Osthoff et al did not assess any patient outcomes 6 and are perhaps a more theoretical consideration. As mentioned in our article, we recommend humidification of airway gases, chest physiotherapy, lung recruitment maneuvers, use of bronchodilators if necessary, and suctioning of the endotracheal tube to mobilize secretions and avoid atelectasis. 2