Re: "Dueling Over Propofol" (October, page 32). The question isn't whether propofol is a sedative or a general anesthetic. You can use many drugs, including Versed alone, to induce general anesthesia. The definition of where a patient lies on the continuum from mild sedation to general anesthesia is irrespective of what medicine you administer and what airway management you utilize. Propofol quickly spans the entire spectrum, and if you use it under the guise of "conscious sedation," there will be innumerable patients who are indeed under general anesthesia - but with a callous disregard for airway protection. There is a prevalent misperception that it isn't general anesthesia if the patient isn't intubated. I would suggest that a study using a level-of-consciousness monitor would demonstrate the disparities in the level of sedation.

Jonathan McMullen, MD
Medical Director, Shoreline Surgical Center
Guilford, Conn.
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According to an AORN standard of practice, the RN when administering conscious sedation is solely responsible for nothing else other than administering the sedation and monitoring that patient just as a qualified anesthesia person would do. I can't imagine that any responsible nurse would do anything other than monitor the patient.

Linda A. Terzigni, RN, BSN, CNOR
Nurse Administrator
Harford County Ambulatory Surgery Center
Edgewood, Md.
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It's the few cases that would benefit from the expertise only an anesthesiologist can provide (and you never really know which cases it's going to be) that concerns me. I suggest that you print the ANA Position Statement so that every RN knows exactly what criteria needs to be met in providing IV sedation.

Susan Anello, RN, BSN, CPSN, CNOR
Administrator
The Advanced Plastic Surgery Center
Yonkers, N.Y.
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Many people are working very hard to determine appropriate ways to provide propofol in a safe and cost-effective environment. Your ridiculous suggestion of giving a patient bourbon and a small hunk of wood was offensive and patronizing.

Deborah McMillin, RN, MSN
Administrator
Baptist Ambulatory Surgery Center
Nashville, Tenn.
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Show Me the Shaving Proof
Re: "How Would You Prep This Patient?" (August, page 37). I have challenged our OR manager and director of nursing education to find me a study that shows, as you suggest, that shaving immediately before a surgical procedure causes more post-operative wound infections. I understand the logic behind AORN's position to reduce or completely avoid sharp razor prep, but it has no evidence to support its conclusions. You state that "shaving increases the bacterial load at the operative site." This may be correct, but this doesn't necessarily translate into more infections.

Charles J. McGaff, Jr., MD, MBA, FACS
River Parishes Surgical Associates
La Place, La.
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