- Email: [email protected]
Authors Answer Criticisms
LETTERS TO THE EDITOR
Authors answer criticisms In 20 years of reading the j a d a , I have never seen an article so dam aging to dentistry, and oral surgery in particular, as this (Hidden Haz ards o f the McKesson Narmatic Anesthesia Machine, Sept 1970, j a d a ). Through derogatory implica tions and omissions, the authors have conveyed ideas that may well be totally false. I make no defense for the Narmatic, but anyone with anesthetic experience must seriously question the person or persons giv ing the anesthetic in this tragedy, and not the machine. In the title, introduction, and con clusions, serious charges are made regarding the Narmatic, but in the collection of data almost all ref erences are made to the failure of the Magill configuration which is ex traneous to the Narmatic. The omis sions are many. Why was the anesthetic continued after “bradycardia and severe hypo tension” at the end of one hour? What was the nature of the oral sur gery procedure that forced contin uance after this episode? Where was the anesthetic given— hospital, medical office, dental office? Who was the anesthetist— MD, RN, DDS? What was the premedication? Were there any supplemental medications during the procedure? What was the preoperative status of the patient? Why wasn’t an absorber used? Was the patient monitored for vital signs continuously— a must with any form of anesthesia but particularly with Fluothane. Oral surgery has worked hard in recent years to upgrade office gen eral anesthesia. Articles of this type,
poorly written with questionable data and wild conclusions, only cause divisiveness and anger. In conclusion, might I ask that you admonish your reviewers to be more thorough in their selection of articles. Just because something is written on a large grant from a great university does not make it factual and honest. JOHN B. MCMANUS RESEDA, CALIF
I fully realize that a publication such as the j a d a must publish ar ticles reflecting many viewpoints. However, I must support my col league, John McManus, in his at tempt to make you understand the potential damage that a publication of such an article may unwittingly do. Organized dentistry and oral sur gery have for many years made an untiring effort to upgrade the pro fessional services to our patients. Gains have been made very slowly and at great personal sacrifices. Much of the work done in regards to anesthesia never reaches the level of administration of the ADA. However, publication of an article such as this automatically reaches the majority of dentists in this coun try, and implies that the statements made have been reviewed and found to be factual. I sincerely hope that in the future serious consideration will be given before an article, as damaging as this one, is printed in the j a d a . IRWIN A. WEINSTEIN, DDS NORTH HOLLYWOOD, CALIF
The adage “a poor carpenter always blames his tools” seems to apply to the above stated article. There is no question that the concentration of
oxygen delivered to the patient may not be the same as the calibration on the dials indicate. The article states that at the setting which was used, the delivered concentration was al ways in excess of that delivered. This is a plus factor. It is also true that a carbon di oxide accumulation and an increased halothane concentration are possible in the type of system that was uti lized. However, the human factor far outweighs these intrinsic prob lems. The following questions should be answered: — 1. Are we to believe that the anesthetist did not know the dangers inherent in the system? — 2. W hat was everyone doing while the patient was progressing toward the first cardiovascular col lapse? — 3. Why did they continue? Was the procedure so important that they had to continue? No mention was made of an endo tracheal tube. Are we, therefore, to assume that for almost two hours, an extremely long office anesthetic, the anesthetic was delivered through a nasal mask? These are the factors that are im portant, not the machine. To con demn the McKesson machine when there are so many other factors in volved is a mistake. The authors mention in one statement that it is adequate for demand flow, but fol low with the statement that it should not be used at all. Very inconsistent. If all the questions which were asked above were answered in the article, this letter would not be nec essary. ALLAN S. SHAW, DDS PHILADELPHIA
Authors’ Comments: Collection of data in preparation of our article was indeed confined to the N ar matic anesthesia machine utilized in the Magill configuration. As stated at the beginning of the article, no attempt was made to comprehen sively describe the performance char acteristics of this machine. Personal (Continued on page 271) 269
Authors answer criticisms In 20 years of reading the j a d a , I have never seen an article so dam aging to dentistry, and oral surgery in particular, as this (Hidden Haz ards o f the McKesson Narmatic Anesthesia Machine, Sept 1970, j a d a ). Through derogatory implica tions and omissions, the authors have conveyed ideas that may well be totally false. I make no defense for the Narmatic, but anyone with anesthetic experience must seriously question the person or persons giv ing the anesthetic in this tragedy, and not the machine. In the title, introduction, and con clusions, serious charges are made regarding the Narmatic, but in the collection of data almost all ref erences are made to the failure of the Magill configuration which is ex traneous to the Narmatic. The omis sions are many. Why was the anesthetic continued after “bradycardia and severe hypo tension” at the end of one hour? What was the nature of the oral sur gery procedure that forced contin uance after this episode? Where was the anesthetic given— hospital, medical office, dental office? Who was the anesthetist— MD, RN, DDS? What was the premedication? Were there any supplemental medications during the procedure? What was the preoperative status of the patient? Why wasn’t an absorber used? Was the patient monitored for vital signs continuously— a must with any form of anesthesia but particularly with Fluothane. Oral surgery has worked hard in recent years to upgrade office gen eral anesthesia. Articles of this type,
poorly written with questionable data and wild conclusions, only cause divisiveness and anger. In conclusion, might I ask that you admonish your reviewers to be more thorough in their selection of articles. Just because something is written on a large grant from a great university does not make it factual and honest. JOHN B. MCMANUS RESEDA, CALIF
I fully realize that a publication such as the j a d a must publish ar ticles reflecting many viewpoints. However, I must support my col league, John McManus, in his at tempt to make you understand the potential damage that a publication of such an article may unwittingly do. Organized dentistry and oral sur gery have for many years made an untiring effort to upgrade the pro fessional services to our patients. Gains have been made very slowly and at great personal sacrifices. Much of the work done in regards to anesthesia never reaches the level of administration of the ADA. However, publication of an article such as this automatically reaches the majority of dentists in this coun try, and implies that the statements made have been reviewed and found to be factual. I sincerely hope that in the future serious consideration will be given before an article, as damaging as this one, is printed in the j a d a . IRWIN A. WEINSTEIN, DDS NORTH HOLLYWOOD, CALIF
The adage “a poor carpenter always blames his tools” seems to apply to the above stated article. There is no question that the concentration of
oxygen delivered to the patient may not be the same as the calibration on the dials indicate. The article states that at the setting which was used, the delivered concentration was al ways in excess of that delivered. This is a plus factor. It is also true that a carbon di oxide accumulation and an increased halothane concentration are possible in the type of system that was uti lized. However, the human factor far outweighs these intrinsic prob lems. The following questions should be answered: — 1. Are we to believe that the anesthetist did not know the dangers inherent in the system? — 2. W hat was everyone doing while the patient was progressing toward the first cardiovascular col lapse? — 3. Why did they continue? Was the procedure so important that they had to continue? No mention was made of an endo tracheal tube. Are we, therefore, to assume that for almost two hours, an extremely long office anesthetic, the anesthetic was delivered through a nasal mask? These are the factors that are im portant, not the machine. To con demn the McKesson machine when there are so many other factors in volved is a mistake. The authors mention in one statement that it is adequate for demand flow, but fol low with the statement that it should not be used at all. Very inconsistent. If all the questions which were asked above were answered in the article, this letter would not be nec essary. ALLAN S. SHAW, DDS PHILADELPHIA
Authors’ Comments: Collection of data in preparation of our article was indeed confined to the N ar matic anesthesia machine utilized in the Magill configuration. As stated at the beginning of the article, no attempt was made to comprehen sively describe the performance char acteristics of this machine. Personal (Continued on page 271) 269