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To the Editor:—
In the article, "Chronic Obstructive Emphysema: The Thoracic Surgeon's Position" (JAMA192:365-367 [May 3] 1965), Minas Joannides, Jr., MD, dictates anesthetic management, "Anesthesia should be given through a negative phase respirator."Anesthetists have learned that a negative phase in a mechanical ventilator is far from effective from a ventilatory aspect; resistance increases from bronchiolar collapse, and compliance may decrease with decrease in lung volume. Bronchial obstruction will consequently increase in obstructive emphysema which is characterized by resistance to air flow. Both hypercarbia and hypoxia should be exaggerated. For anesthesia in a patient with obstructive emphysema, positive pressure respiration both during inspiration and expiration with sufficient decrease during the latter phase to permit adequate venous return is the most desirable technique.
Berkowitz S. Anesthesia in Emphysema. JAMA. 1965;193(4):320. doi:10.1001/jama.1965.03090040064022
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