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On anesthesia services

Red Hook, New York, Usa

To the Editor:

The paper by Le May¹ reveals disquieting gaps between title and content and misconceptions about the use of words. The title appears to address issues of anesthesia service but the questionnaire includes a question concerning "adequate" relaxation. This is not a "service" (such as billing from a credit card company) rather it is a subjective evaluation by one professional about the technical performance of another although the one making the judgement is not qualified to perform that same procedure. An inept surgeon who cannot develop adequate exposure will complain about relaxation even when the patient, the anesthesiologist and the circulating nurse are all drowning in a sea of curare. Such a questionnaire should have required each surgeon to rate each anesthesiologist progressively on a case by case basis. If all the surgeons complained about the same anesthesiologist one might have proved a point. However, if one surgeon had complained all the time about all of the anesthesiologists then the picture would be different.

Another issue raised was that of "providing stable conditions". This is too vague to be quantified, again by somebody who is not qualified to perform that same procedure. Furthermore, at least with reference to the blood pressure, continuous automatic monitoring and recording has shown that instability of the blood pressure during anesthesia is the norm rather than the exception. The origin of the myth of the stability of the patient during anesthesia lies in the origin of the hand-made anesthesia record which in fact is a record of the anesthesiologist's perception, and what controls it, rather than a true anesthesia record.

Reference

1 Le May S, Dupuis G, Harel F, Taillefer M-C, Dubé S, Hardy J-F. Clinimetric scale to measure surgeons' satisfaction with anesthesia services. Can J Anesth 2000; 47: 398–405.[Abstract/Free Full Text]

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