LETTER
Anesthesia Not Related to Fludarabine Toxicity
Kenneth E. Shepherd
1 September 1993 | Volume 119 Issue 5 | Page 437
TO THE EDITOR:
I read with interest the brief report by Cohen and colleagues [1] about reversible neurologic toxicity associated with fludarabine. What caught my eye was the statement that "general anesthesia (Patient 2) may have potentiated fludarabine toxicity". The authors note that the "surgery in Patient 2 was brief, limited in scope, and uncomplicated".
I generally appreciate the contribution of the medical evaluation in complex perioperative patients, but some internists' recommendations can be irritating and can have medicolegal implications [2]. I pose this question to Dr. Cohen and his coworkers: Are there specific data concerning fludarabine and anesthesia to support their statements or is this simply conjecture?
1. Cohen RB, Abdallah JM, Gray JR, Foss F. Reversible neurologic toxicity in patients treated with standard-dose fludarabine phosphate for mycosis fungoides and chronic lymphocytic leukemia. Ann Intern Med. 1993; 118:114-6.
2. Keats AS. The estimate of anesthetic risk in medical evaluations. Am J Cardiol. 1963; 12:330-3.
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