Regarding Dr. Pollock's concluding statement (page 3 ASRA News August 2000) concerning survey respondents not universally embracing new local anesthetics, perhaps the choice is not theirs to make. Anesthesiologists use what is supplied to them by their pharmacies, with the formulary having multiple influences beyond the requests of the anesthesiologist. The survey fails to justify her conclusion.
Sincerely,
Charles Richards, MD
Reply from the Editor,
I appreciate the comments of Dr. Richards and would certainly agree that the anesthesiologist's choice of drugs is limited by formulary availability. Nonetheless, the enthusiasm of patients and anesthesiologist for particular drugs (propofol, ondansetron, and sevoflurane to name a few) frequently has outweighed the financial concerns of formulary committees. This approval of new, more expensive drugs usually occurs when the products are seen as having overwhelming benefits for patients such as decreased side effects or improved discharge time. Perhaps the lack of universal formulary approval for new, more expensive local anesthetics mean that the reported advantages of these drugs are not fully appreciated by physicians, patients and pharmacy and therapeutic committees.
