To the Editor
I found the Spring issue of the APSF Newsletter to be the most thought provoking and controversial issue to date. Whether or not reading in the operating room disparages the image of the Anesthesia Care Team member is not the issue. Does it affect the outcome of the case? Too often studies are based on the investigation of one variable, but rarely do we read of outcome studies. Perhaps if anesthesiologists at teaching institutions spent most (if not all) of their time teaching in the operating rooms each and every case, residents would not feel compelled to read during the case to supplement the lack of information provided via less-than-optimal lecture series. This would help to overcome the image of the anesthesiologist working on his personal finances on his laptop in the OR so shamelessly painted by the surgeon who chose to remain anonymous. I assume that this vigilant surgeon is always in the operating room, from induction of anesthesia to the transfer to the cart at the end of the case, even though he works at six different facilities.
The controversy over succinylcholine use will continue to rage on for years until a non-depolarizing neuromuscular blocking drug is developed that mimics succinylcholine in onset, duration, and cost yet has no side effects or active metabolites. Dr. Steven S. Kron, in his letter to the editor (APSF Newsletter Vol. 10, No. 1, p. 2) promulgates the use of less costly drugs, such as pancuronium, metocurine, curare and succinylcholine drips based solely on estimated length of time the case will take. Once again, the use of outcome studies proves this line of thinking based entirely on cost to increase risk to the patient by having unrecognized residual neuromuscular blockade present in the recovery room from using such long-acting, yet cheap, drugs. Dr. Kron fags to mention the cost of adjuvant drugs to offset the side effects of or to reverse these cheaper drugs. This type of misinformation leads practitioners or those in training to believe that we are doing patients a service by using the cheaper drug. While cost is an issue, safety comes first. We have the ability to provide anesthesia that is safer today than ever before, partly due to the development of newer and better drugs with safer profiles. Forcing residents in anesthesia training programs to use pancuronium on any case longer than “x’ minutes denigrates them to the ‘tube tech’ image we must avoid. Residents are there to learn the art of administering anesthesia with various techniques, drugs and approaches. To stifle them is to lose what our specialty thrives on, i.e., the knowledge of and ability to use all drugs in our armamentarium and to use these drugs appropriately in each situation. This is what the American Board of Anesthesiology promotes when granting the title of Diplomate as a consultant in anesthesiology.
Thomas W. Durick, M.D. Chief of Anesthesia: Meadville (PA) Medical Center