To the Editor.—
Hillis and Cohn's clinical review, "Noncardiac Surgery in Patients With Coronary Artery Disease" (Archives 138:972-975, 1978), is incomplete. The point is well made that all general anesthetics depress the mechanical performance of the heart. But the days of diethyl ether and cyclopropane are over! Electrosurgical equipment, monitors, x-ray machines, and the like have made flammable agents passé.1Methoxyflurane has the potential for renal toxicity2 and is losing favor.A new general anesthetic agent, enflurane (Ethrane), is gaining wide-spread acceptance because of its freedom from serious hepatotoxicity in more than 10 million cases (Edmond I. Eger II, MD, oral communications, 1977 and 1978). Clinically and in laboratory studies the negative inotropic effect of enflurane is dose related and may be more intense than that of halothane.3The article also fails to mention the frequent adverse effects of neuromuscular relaxants: hypotension (tubocurarine chloride) and tachycardia (pancuronium).