Re: "Anesthesia: A Medical Mainstay Re-examined" [May 14], thank you for publishing this article. In general, this report was accurate, emphasizing our continuing commitment to advancing the science of anesthesiology and the comfort and well-being of those for whom we care.
It is imperative to point out several caveats to the research in the article. The exposure of laboratory animals to anesthetic agents is very different than the administration of surgical anesthesia to patients. Physiologic monitoring of breathing, circulation, oxygenation, and many other measures of optimal conditions during an anesthetic is rigorous and continuous for even the most simple and routine procedure. This may be difficult to replicate in experiments, especially on newborn animals.
As a pediatric anesthesiologist, I can say that no anesthetic is administered to an infant or child without careful consideration of the risks. Anesthesiologists, particularly pediatric anesthesiologists, are well aware of the reports showing harm to developing animals after exposure to anesthetic agents. Research scientists are working to determine if these early results have application to children.
Thus far, experts agree that there is no evidence to suggest that infants should have surgery canceled or delayed. Lastly and most importantly, the article suggested that perhaps it would be reasonable to postpone an "elective" repair of a cleft lip in a young infant until the child was 3. This would be considered malpractice by current standards of care in any developed country.
This operation is performed on babies at about one month because the closure of the lip is extremely important in nutrition, allowing the baby to nurse or bottle feed, and a delay in the surgical correction of the lip (and often associated cleft palate) will also undermine speech and language, as well as psychosocial, development.
MARK A. SINGLETON, M.D.
The writer is president of the California Society of Anesthesiologists.