Letters To The Editor Last Word on Point:Counterpoint: Hypoxia is/is not the optimal means of reducing pulmonary blood flow in the preoperative single ventricle heart

this debate for their insightful remarks (2, 7). Children’s Hospital of Philadelphia has been at the forefront in the study and use of various gas mixtures to manipulate pulmonary vascular resistance in the preoperative single ven-tricle setting. The remarks of Dr. Jobes (2) from the Depart-ment of Anesthesia pertaining to the superiority of inhaled carbon dioxide to achieve hemodynamic stability in the imme-diate perioperative setting complement the published study of Dr. Tabutt and her colleagues (5) from the same institution, as reviewed in detail in our original Counterpoint (4). Dr. Prakesh (2) raises some interesting points. We agree that buffering hypercapnic acidosis with sodium bicarbonate will worsen the intracellular pH in any situation when ventilation is inadequate, and by no means advocate its use. Indeed, the pulmonary protective effects of hypercapnic acidosis are los