To the Editor:—
Perhaps the greatest shortcoming in our specialty is that anesthesia has little or no direct therapeutic benefit for the patients for whom we care. Over the years our specialty has diversified into fields such as critical care, pain management, patient safety, and quality assurance, all of which involve the therapeutic management of patients. Thus, the recent observations that certain anesthetics may possess therapeutic effects 1is greeted with pleasure by most of us. However, we must remember that these anesthetics (in particular the volatile agents) have been in use for years and that their administration has never been demonstrated to decrease morbidity or mortality. 2,3
Warltier et al. in their editorial 1suggest that the anecdotal suggestions of a reduced frequency of ischemic events and pharmacological or mechanical support after cardiac surgery is caused by the “relatively greater use of volatile anesthetics” because these agents posses cardioprotective properties.
However, cardiac surgery appears an inappropriate field in which to study this question. Aortic clamping and unclamping are dependent on the surgeon (intentional or unintentional ischemic preconditioning) and the array of cardioplegia cocktails, anterograde, retrograde, continuous, intermittent, cold, warm perfusia, and so on, are but a few of the factors that affect outcome and are difficult to control. Thus, to demonstrate the clinical benefits of anesthetic preconditioning, the study of high-risk surgical patients undergoing noncardiac surgery procedures appears potentially more fruitful.
