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To the Editor.—Dr. Richard Keenan's petulant remarks (Archives 105:802, 1972) as to why anesthetists might choose explosive agents for their patients are certainly tangential to the main stream of responsible thought in the specialty of anesthesiology.
No anesthetic agents are ideal in all clinical settings. All present inherent risks and may result in complications. Spinal anesthesia results in headache and neurological sequelae in some. Halothane may initiate a rare severe sensitizing hepatitis. Methoxyflurane can produce transient renal disorder. Tranquilizer and opiate—nitrous oxide—relaxant combinations require ventilatory control throughout the surgical procedure and may result in uneven levels of anesthesia with patient awareness and significant postoperative respiratory insufficiency. The explosive agents—ether and cyclopropane—may have advantage particularly in chest procedures when large shunts are performed, and for the critically ill, since these agents can be effectively administered with 100% oxygen as the vehicle gas.
Since an ideal anesthetic agent is not yet
AMENT R. Anesthetic Choice. Arch Surg. 1973;106(3):364. doi:10.1001/archsurg.1973.01350150098030