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July 10, 1967

A Problem in Anesthesia Management

JAMA. 1967;201(2):144. doi:10.1001/jama.1967.03130020090038

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To the Editor:—  The article entitled "Permanent Alopecia From Pressure of a Head Strap" (199:747, 1967) was of considerable interest.It is noted, however, that the age of the patient was 4 years and the duration of the anaesthetic 6 1/2 hours. Hence, I feel that in similar cases the answer is not in more careful positioning of the head strap, but rather a change in anaesthetic technique: to use an appropriately sized pediatric orotracheal tube (to reduce dead space) and low-resistance circle or high-flow open anaesthetic circuit. Further, in such a young patient and an operation lasting as long as this, a case can be made for intermittent positive pressure ventilation with use of tubocurarine or halothane to depress respiration. This would ensure maintenance of favorable oxygen and carbon dioxide arterial gas tensions and prevent respiratory acidosis. Further, oxygen consumption would be reduced and the child would be