Expert: Ronald Levy, M.D. - 4/22/2009

Question
Hi,

My question is, why do teenagers and adults have to go
under anesthesia by IV induction and not by the mask? What
is the purpose of that? Because I've had a lot of surgeries
in the past and when I was younger they'd always used the
mask, but now that I'm a teen they want to use the IV but I
don't like the IV induction. So can I tell them that I'm
more comfortable with the mask or is there no choice for
me?

Answer
As you go off to sleep by mask, it is a slower process and you go through something called Stage II. During this time, even though you are asleep you can get very agitated and are at risk for aspiration and something called larygospasm. With IV induction, you pass through this phase in a matter of seconds. We do mask inductions in babies and small children so they are not scared of the IV (they don't understand our explanations) but since they are small, we can hold them down until they pass through Stage II. For teens and adults, they understand the slight pain as they get the IV put in, but the induction is actually more plesant. Furthermore, if an adult were to get agitated, he might hurt himself or someone else, so we generally don't do mask inductions on adults. That being said, it CAN be done and you are welcome to discuss it with your anesthesiologist but now you understand his reasoning.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston