To the Editor

Dr. Balaklaw wonders (APSF Newsletter, Summer 1990) whether his mode of practice (not routinely have a “free” anesthesiologist available to deal with problems in the PACU) meets my standards. While I was not aware that anyone had appointed me an authority on the standard of care for medical coverage of a PACU (1), I would make the following comments:

According to his letter, Dr. Balaklaw works in a hospital setting, where there is a cardiac arrest team immediately available on call to handle cardiorespiratory emergencies. He notes that this team includes a number of individuals who are skilled in airway management techniques. His situation is, therefore very different from that of Dr. Figueroa, whose letter prompted my earlier comments (APSF Newsletter, September 1989). The latter physician worked in a free-standing Suigicenter, where no other comparably trained personnel were available. In my previous letter, I opined that: “An anesthesiologist who commences the “solo” administration of anesthesia to a patient for an elective case, leaving other patients for whom he has accepted responsibility in the recovery room without the immediate availability of another appropriately skilled and qualified individual to render needed emergency care [new emphasis] is, to my mind, already guilty of abandoning those patients.” Although I would regard the circumstances of Dr. Balaklaw’s practice as less than ideal, and would personally be very uncomfortable with not having an anesthesiologist available to deal with potential problem in the PACU, I am inclined to agree with him that his practice mode meets a reasonable standard of cam

Peter R. Fletcher, M.A., B.M., B.Ch. Delaware County Memorial Hospital, Drexel Hill, PA