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November 15, 1985

Cardiac Arrest and Anaphylaxis With Anesthetic Agents-Reply

JAMA. 1985;254(19):2742. doi:10.1001/jama.1985.03360190047024

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In Reply.—  We are grateful to Forand and colleagues for calling attention to what should be a "hot" topic among anesthesiologists for the next few years.We agree that routine monitoring of blood oxygenation would not have warned the anesthetist of trouble in all the cardiac arrests in our report. But it would have given a valuable early warning in an important subset, as Forand et al suggest. Their contention that "hypoxia would have been a late sign" is a mere quibble. Our experience is that a monitored fall in saturation to as low as 50% occurs well before bradycardia is observed, and serves as a timely and very dramatic warning of a misplaced endotracheal tube.End-tidal carbon dioxide monitoring might prove to be an even better monitor of general well-being than oximetry. Any interruption in breathing would be immediately obvious; low cardiac output states might also be detected. Mass