To the Editor-Although I enjoy some articles in your journal, the article "HCFA Removes Supervision Requirement for CRNAs" was biased. Not until the second paragraph do you mention that the Bush Administration suspended the ruling. Forty years of studies repeatedly show that anesthesiologists provide the best possible care. In making this change, Mr. Clinton and HCFA ignored HCFA's own internal physician advisory committee, all 50 state medical societies and the top surgical societies.

Regarding your editorial on questioning policy, we tried allowing late-morning and early-afternoon patients to have clear liquids up to three hours prior to surgery. Compliance was poor. We also could not move later-scheduled patients to morning when cancellations occurred. We now prohibit solids after midnight and clear liquids after 5 am for morning cases. Afternoon patients are NPO after 9 am.

Tip #6 in "7 Ways to Build Your Arthroscopy Service" advises switching from inhalation anesthesia to IV remifentanil, followed by Demerol and Marcaine, both intramuscularly. Perhaps you meant intra-articular or intracapsular. No one would inject a local IM for pain relief in this setting. Also, an inhaled anesthetic costs much less than IV remifentanil, especially at low flow and with a BIS monitor.

Finally, obese patients should be done at the hospital, not at an ASC. You need back-up support from other anesthesiologists, equipment to handle everything from difficult intubations to cricothroidotomy, and the ability to admit a patient to critical care. We do not book patients with a BMI above 40.- Marc T. Reichel, MD, Medical Director, Beaufort Surgery Center, Beaufort, S.C.

Corrections

• In "A Manager's Guide to Endoscope Reprocessing Products" (Jan.) we reported that Olympus does not list ortho-phthalaldehyde (Cidex OPA Solution, Advanced Sterilization Products) as a compatible agent with its scopes. Olympus does list Cidex-OPA as a compatible agent as of Aug. 24, 2000.
• Our February article "Should You Buy Cataract Instruments Online?" omitted two providers. Rhein Medical offers its inventory online; www.rheinmedical.com provides pictures and information on most of its instruments. Spectrum Surgical offers more than 30 cataract instruments, including specula, forceps, scissors, needleholders and more, at www.spectrumsurgical.com.
• "How to Buy an OR Microscope" (March) omitted Med Link's Z880 Reconstructive Microscope. It offers dual magnification, assistant fine focus, independent rotating heads, and other features. Call (800) 762-7921 or visit www.medlinkusa.com.
• Our March Product Showcase should have listed Surgery Center Consultants at (770) 939-2799.
• Our March headline "Bankrupt ASC Sues Hospital..." was incorrect. The Rome ASC, while closed, has not declared bankruptcy.