Anaesthetic machines

With reference to the letters in the July issue (Anaesthesia 1999; 54: 703±7), I should like to express my support for the views of Dr Cartwright concerning dental anaesthesia. The time has surely come to call a halt. It is now almost exactly six months since, after more than 30 years of dental anaesthetic practice, and approximately 15 000 anaesthetics, I administered my last `chair' anaesthetic. The dentists I worked with decided to call a halt, partly due to adverse publicity and partly to changes in the fee structure. I had no regrets since I have felt, increasingly in recent years, that the dental surgery is no longer an acceptable place to administer a general anaesthetic. Over the years, demand has fallen steadily and when I gave up this service in mid-January, I had been attending three dental practices on a monthly basis, anaesthetising a total of about 30 patients per month. I recently telephoned the three dentists in question to ®nd out how many patients they had to refer on as untreatable in the last six months. The total is about three per month, or 10% of the number of patients we were treating until six months ago. This is from a total NHS population which yields quite a few patients with serious dental neglect. The implication is therefore that 90% of the patients I had been anaesthetising could have been managed without a general anaesthetic. The remaining 10% could be referred to the local hospital's dental department without swamping the system. I rest my case! H. L. Goldwater Prestwich, Manchester M25 0FR, UK