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.
writeMail("mullymd@comcast.net")