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October 14, 1983

Spinal and General Anesthesia

Author Affiliations

Union Memorial Hospital Baltimore

JAMA. 1983;250(14):1842. doi:10.1001/jama.1983.03340140018015

To the Editor.—  Spielman and Watson, in their article entitled "Spinal Anesthesia" (1983;249:734), present an overly optimistic view of spinal anesthesia. However, there are caveats to be noted.

  1. Arterial hypotension induced by spinal anesthesia that can be eliminated by 500 to 1,000 mL of fluid or α-and β-stimulating drugs places the cardiac patient at high risk, since he may be unable to tolerate such therapy. Overall mortality, postoperative myocardial infarction, and arrhythmia are not diminished by spinal anesthesia.1 In the elderly with hip fractures, spinal and general anesthesia have the same mortality.2

  2. Although evidence may indicate that a normal person does not suffer impaired resting ventilation, patients with pulmonary disease are at high risk for pulmonary complications. With general anesthesia and intubation, support and convalescence can be continued as long as needed.2

There is no question that spinal anesthesia is safe in a normal person,