To the Editor:--Anesthesiology is reaching a new low when we worry about and calculate cost per minute of anesthesia time; particularly because the difference is pennies per minute. The cost analysis by Macario et al. [1]compares the cost of different methods of airway management--mask, laryngeal mask, and endotracheal tube--and drug costs with each. The assumption is such that, with a mask, gas flows of 6 l/min must be used. The authors seem unaware of the fact that it is possible (and was standard practice) to use even a closed system with a mask. Flow rates of 300-400 ml/min were customary. I am sure that low flows would have a major impact on the calculations and would make the mask method best by far. It should come as no surprise to anyone that reused items are less costly than disposables.

What troubles me is that what is best for the patient is not even considered. Is inconvenience for the anesthesiologist more important?

I have yet to see surgeons calculating the cost per stitch for suture materials, swedged-on needles, disposable versus reusable sponges, drapes, and other items. Expensive high-technology surgery is acceptable and sought. It is demeaning for the anesthesiologist and a disservice to patients that we should consider pennies per minute to be important.

When I have my operation, I want what is best for me, not what is cheapest and most convenient for the anesthesiologist.

Primum non nocere.

Jay Jacoby, M.D., Ph.D., Professor, Department of Anesthesiology, The Ohio State University Medical Center, 410 West 10th Avenue, Columbus, Ohio 43210-1228.

Macario A, Chang P, Stempel D, Brock-Utne J: A cost analysis of the laryngeal mask airway for adult elective outpatient surgery. ANESTHESIOLOGY 1995; 83:250-7.