Provoked Thoughts

Thomas J. Lawton, M.D.

To the Editor

Having read the Summer 1993 edition of the APSF Newsletter, I felt the need to comment on some of the contents.

1. ETC02 monitoring Such monitoring has been a prerequisite for every general anesthetic done by the undersigned since 1974. 1 do believe it to be one of the most reliable monitoring systems available for anesthesiologists, but I would disagree with any physician who would cancel a case WITHOUT its availability. Perhaps there’s a place in a training program for clinical judgement.

2. Disconnecting epidural catheters Disconnecting an epidural catheter is the sole responsibility of the anesthesiologist in charge. Rather than rehash the appropriate cover-up for a mistake, perhaps more attention to correct training would be time better utilized.

3. ‘A little potassium’ The erroneous dosage of a bolus of potassium seems to have been the result of an attempted mechanical pump administration instead of appropriate “brain power.’

4. “What to do with the older anesthesiologist?” There are many older anesthesiologists who cringe at the younger products of some of today’s training centers. Some of these newly trained anesthesiologists come into the work place unable to:

a. do an epidural anesthetic with confidence. b. manage K+ dosage without a pump.

c. manage general anesthesia without a huge

battery of monitors.

d. administer a safe anesthesia for delivery and/or resuscitate a newborn.

These factors bring this critique to the bottom line. Perhaps among all the retired or senior inactive anesthesiologists with a wealth of practical experience and clinical judgement, there may be a reservoir of possibilities to be utilized by teaching institutions for the asking.

Thomas J. Lawton, M.D. La Habra, CA