To the Editor.—The article by Bergan et al1 about the late effects of surgery for management of peripheral artery disease renews important issues that should not be dismissed lightly.
While the authors postulate unsuspected and unknown side effects of surgery, one should not ignore that operations and their side effects cannot be separated from the companion side effects of anesthesia. On this, one should note that the literature pertaining to the immunosuppressive effects of nitrous oxide is too voluminous to be discussed in this brief communication. As for the late effects of volatile halogenated agents, there exists well-documented actuarial evidence that halothane lowers the life expectancy curve of mice long after cessation of its administration.
It is also worth noting that careful independent scrutiny2 of previously reported data yields data that are very similar to those reported by Bergan et al. At this time, the conclusion would