To the Editor:
It is commendable that Yogendran et al.  have confirmed what many of us have felt for some time (i.e., well hydrated patients fare better). However, 86% of their patients had dilatation and curettage (D&C). Many of us anesthetize women for D&C (98% of patients in my practice) with a paracervical block/intravenous (IV) sedation technique. A 70-kg patient would typically receive midazolam 1-2 mg IV, 30 min preoperatively; in the operating room she would receive midazolam 1-2 mg IV, fentanyl 50 micro gram IV, ketamine 20 mg IV, and if needed, propofol 20-30 mg IV before and during paracervical block placement. This reduction in medication load alone would probably decrease postoperative side effects, such as nausea, vomiting, dizziness, and drowsiness, and recovery room stay. Validation would have been better if this study had included significantly more subjects, such as patients undergoing laparoscopies and orthopedic procedures, which are characterized by increased side effects and longer recovery room stays.
There were allusions to speed of recovery, home readiness, and early discharge in the paper. However, recovery room times were not reported or compared in the two groups.
Michael K. Rosenberg, MD
Department of Anesthesiology, Sinai Hospital, Sinai Surgery Center, Farmington Hills, MI 48334
1. Yogendran S, Asokumar B, Cheng DC, Chung F. A prospective randomized double-blinded study of the effect of intravenous fluid therapy on adverse outcomes on outpatient surgery. Anesth Analg 1995;80:682-6.