February 11, 1974

Selection of Anesthetic

Author Affiliations

Fresno Community Hospital Fresno, Calif

JAMA. 1974;227(6):661. doi:10.1001/jama.1974.03230190053028

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To the Editor.—  The comments of Edwin J. Goldman, MD (226:1120, 1973) regarding the central nervous system (CNS) excitation produced by enflurane ("Enflurane and Catch 22×3") may be well taken, in that it is sometimes difficult for us in clinical anesthesiology to make a rational decision regarding which of the halogenated agents to use in a given case. In our department, however, the advent of enflurane (ethrane) has dovetailed very nicely with our prior trend from halothane to more so-called balanced anesthesia, and has enabled us to get by with low concentrations of enflurane that are probably insufficient to produce any considerable degree of CNS excitation or other organ damage. We use primarily either a mixture of droperidol and fentanyl citrate (Innovar) or fentanyl citrate (Sublimaze) with the N20:02 for this purpose, and naloxone hydrochloride (Narcan) reverses the narcotic so effectively at the termination of the case that most patients