Bacchus Listed for a Liver Transplant: Comment

wished to make in our Editorial is that the hypothetical risks of anesthetic neurotoxicity should not dictate our choice of regional versus general anesthesia.There is no evidence of the superiority of one approach over the other in terms of clinically relevant outcome.Therefore, the skills and expertise of the anesthesiologists and surgeons should be the main factors behind this strategic decision.In academic centers where teaching is a priority, the duration of even straightforward surgical procedures may often exceed the duration of a single spinal block.Given the importance of adequate analgesia during the entire procedure, general anesthesia, often in combination with a regional blockade, may have obvious advantages in these situations.As Drs.Williams and Sartorelli also point out, up to 20% of children with spinal anesthesia may need additional sedation even in experienced hands.While this situation can be easily handled by experienced pediatric anesthesiologists, failure of spinal anesthesia and the subsequent change in management plan may be more dangerous in less experienced hands.Again, it is the anesthesiologist and not the anesthetic that makes the difference.