To the Editor. —As an anesthesiologist and an internist I must comment in regard to the recent article on preoperative pulmonary evaluation.1 An otherwise satisfactory review was marred by the discussion of anesthetic choice for the asthmatic patient. An obvious lack of familiarity with current anesthetic practice and literature was evidenced and several misconceptions were reinforced.
In regard to the inhalational agent of choice there is mounting evidence that the inhalational agents in routine use today (isoflurane, enflurane, halothane) are essentially equivalent in their bronchodilating actions.2,3 In some settings the newer agents may be superior to halothane.2,4 Cyclopropane, an inhalational agent we were cautioned against using, 1 has not been available for years. Like diethyl ether its explosive properties mandated its removal from the operating room environment.
d-Tubocurarine, though still used in the practice of anesthesia, is rarely, if ever, administered in doses that could induce or