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To the Editor: In their trial of preoperative intensive IMT, Dr Hulzebos and colleagues¹ describe the preoperative and postoperative study methods, but the actual conduct of the operative course is only briefly mentioned. A study attempting to determine the efficacy of IMT should control for the many operative variables known to have an effect on the incidence of the measured complications, particularly because there is no specific mention of the blinding status of the surgeon, anesthesiologist, or intensivist.

For example, the choice of the primary anesthetic technique may affect postoperative ventilator time. High-dosed opiate-based techniques routinely require 6 to 14 hours before extubation, in contrast with volatile anesthetic "fast-track" regimens that are associated with much earlier extubation and shorter hospitalization.² Regional anesthesia (thoracic epidural local anesthetics or intrathecal opiates) is routinely used in some centers and can permit accelerated extubation, reduce postoperative pain, and lead to decreased hospital stays.³ Pain . . . [Full Text of this Article]

William C. Culp, Jr, MD
wculpjr@mac.com

Erik A. Beyer, MD
Texas A&M University System Health Science Center College of Medicine
Scott & White Hospital
Temple

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Preoperative Inspiratory Muscle Training and Postoperative Complications—Reply
Erik H. J. Hulzebos, Paul J. M. Helders, Nine J. Favié, Rob A. De Bie, Aart Brutel de la Riviere, and Nico L. U. Van Meeteren
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Preoperative Intensive Inspiratory Muscle Training to Prevent Postoperative Pulmonary Complications in High-Risk Patients Undergoing CABG Surgery: A Randomized Clinical Trial
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